Factors associated with complete clearance of difficult common bile duct stones after temporary biliary stenting followed by a second ERCP: a multicenter, retrospective, cohort study

Endoscopy ◽  
2020 ◽  
Vol 52 (06) ◽  
pp. 462-468
Author(s):  
Dong Kee Jang ◽  
Sang Hyub Lee ◽  
Dong Won Ahn ◽  
Woo Hyun Paik ◽  
Jae Min Lee ◽  
...  
Keyword(s):  
Bile Duct ◽  
Clearance Rate ◽  
Plastic Stents ◽  
Biliary Stenting ◽  
Stone Size ◽  
Stone Clearance ◽  
Complete Clearance ◽  
Factors Associated ◽  
Cbd Stones ◽  
Male Patients

Abstract Background Although temporary endoscopic biliary stenting is considered effective for difficult common bile duct (CBD) stones, few studies have investigated the optimal conditions for complete stone clearance at the second endoscopic retrograde cholangiopancreatography (ERCP) after temporary biliary stenting. We aimed to evaluate factors associated with complete clearance. Methods Patients with difficult CBD stones (a large [≥ 20 mm] or multiple [≥ 3 sized ≥ 15 mm] CBD stones) were retrospectively enrolled from three institutions. Patients who underwent temporary biliary stenting at the first ERCP were analyzed. Double-pigtail plastic stents (7 or 10 Fr) were placed with the proximal ends above the stones. Complete clearance rate and stone size reduction at the second ERCP, and factors associated with complete clearance were evaluated using univariate and multivariate analyses. Results 85 patients were enrolled (mean age 74.5 years [SD 11.3]; 47 women). Stone size and CBD diameter significantly decreased during the interval. The overall complete stone clearance rate was 64.7 % (55/85) at the second ERCP. The mean stone size reduction was 5.6 mm (SD 6.8). In multivariate analysis, complete clearance rate was significantly lower in male patients, in patients aged > 80 years, and in stones > 25 mm initially, but was significantly higher when 7-Fr stents were placed and stone size was reduced by > 5 mm. Conclusion Use of 7-Fr rather than 10-Fr plastic stents was beneficial for complete clearance of difficult CBD stones after temporary biliary stenting; older male patients as well as patients with initial stones > 25 mm had a lower clearance rate.

Digital cholangioscopy-guided laser versus mechanical lithotripsy for large bile duct stone removal after failed papillary large-balloon dilation: a randomized study

Endoscopy ◽  
2019 ◽  
Vol 51 (11) ◽  
pp. 1066-1073 ◽  
Author(s):  
Phonthep Angsuwatcharakon ◽  
Santi Kulpatcharapong ◽  
Wiriyaporn Ridtitid ◽  
Chaloemphon Boonmee ◽  
Panida Piyachaturawat ◽  
...  
Keyword(s):  
Bile Duct ◽  
Radiation Exposure ◽  
Clearance Rate ◽  
Balloon Dilation ◽  
Laser Lithotripsy ◽  
Stone Clearance ◽  
Mechanical Lithotripsy ◽  
Cbd Stones ◽  
Large Balloon ◽  
Large Balloon Dilation

Abstract Background Endoscopic papillary large-balloon dilation (EPLBD) allows for the complete removal of large common bile duct (CBD) stones without fragmentation; however, a significant proportion of very large stones and stones floating above a tapering CBD require lithotripsy. Mechanical lithotripsy and cholangioscopy-guided laser lithotripsy are both effective for stone fragmentation. This study aimed to directly compare, for the first time, the efficacy of these two techniques in terms of stone clearance rate, procedure duration, patient radiation exposure, and safety. Methods 32 patients with very large CBD stones or with stones floating above a tapering CBD, and in whom extraction after standard sphincterotomy and/or EPLBD had failed, were randomly assigned to mechanical lithotripsy or cholangioscopy-guided laser lithotripsy at two tertiary referral centers. Crossover was allowed as a rescue treatment if the assigned technique failed. Results Patients’ demographic data were not different between the two groups. Mechanical lithotripsy had a significantly lower stone clearance rate in the first session compared with laser lithotripsy (63% vs. 100%; P < 0.01). Laser lithotripsy rescued 60% of patients with failed mechanical lithotripsy by achieving complete stone clearance within the same session. Radiation exposure of patients was significantly higher in the mechanical lithotripsy group than in the laser lithotripsy group (40 745 vs. 20 989 mGycm2; P  = 0.04). Adverse events (13% vs. 6%; P  = 0.76) and length of hospital stay (1 vs. 1 day; P  = 0.27) were not different. Conclusions Although mechanical lithotripsy is the standard of care for a very large CBD stone after failed EPLBD, where available, cholangioscopy-guided laser lithotripsy is considered the better option for the treatment of this entity as it provides a higher success rate and lower radiation exposure.

scholarly journals Role of tamsulosin in patients undergoing ESWL for renal and ureteric stones

2020 ◽  
Vol 8 (1) ◽  
pp. 201
Author(s):  
Gyan Prakash Singh ◽  
Sabyasachi Panda ◽  
Pradeepta Kumar Panda
Keyword(s):  
Clearance Rate ◽  
Controlled Study ◽  
Control Group ◽  
Stone Size ◽  
Analgesic Requirement ◽  
Stone Clearance ◽  
Complete Clearance ◽  
The Mean ◽  
And Control ◽  
Mean Time

Background: To determine the effect of tamsulosin, as adjunctive medical therapy on the outcome of extracorporeal shock wave lithotripsy (ESWL) for solitary renal and ureteric calculi.Methods: From January 2017 onwards, a prospective, randomized controlled study was conducted in patients with solitary renal or ureteral calculus measuring less than 20 mm undergoing ESWL. The study group (n=62) received 0.4 mg of tamsulosin daily till stone clearance or a maximum period of 12 weeks and control group (n=58) received ESWL only. Parameters assessed were stone size, composition, location, stone clearance, mean time to clearance, analgesic requirement, steinstrasse, need for hospitalization and/or auxiliary procedures.Results: There was no difference between the 2 groups with regards to age, stone size, location or composition. The complete clearance rate for renal stones was 62.7% and 36.5% (p=0.004) and for ureteric stone was 89.4% and 58.8% (p=0.03) in study and control groups, respectively. The control group had a higher rate of clinically insignificant residual fragments (CISF i.e. <3 mm), 12.9% versus 35.4% (p=0.002). There was no significant difference in the mean time to stone clearance (p=0.07) or in the incidence of steinstrasse formation (p=0.12). The mean analgesic requirement (p=0.01), need for auxiliary procedures and hospitalization (p=0.03) was significantly was higher in the control group.Conclusions: Tamsulosin increase the complete clearance rate and decrease the incidence of CISF. It also reduces analgesic requirement, need of additional procedures and hospitalization rate and might be useful as a routine adjunctive therapy following ESWL.

scholarly journals Factors Significantly Contributing to a Failed Conventional Endoscopic Stone Clearance in Patients with “Difficult” Choledecholithiasis: A Single-Center Experience

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Emmanuel Christoforidis ◽  
Konstantinos Vasiliadis ◽  
Konstantinos Tsalis ◽  
Dimitrios Patridas ◽  
Konstantinos Blouhos ◽  
...  
Keyword(s):  
Bile Duct ◽  
Endoscopic Sphincterotomy ◽  
Statistical Tests ◽  
Bile Duct Stones ◽  
Stone Extraction ◽  
Contributing Factors ◽  
Stone Clearance ◽  
Cbd Stones ◽  
Single Center Experience ◽  
Cbd Stone

The objective of this study is to retrospectively evaluate factors significantly contributing to a failed stone extraction (SE) in patients with difficult to extract bile duct stones (BDS). Patients and Methods. During a 10-year period 1390 patients with BDS underwent successfully endoscopic sphincterotomy. Endoscopic SE was graded as easy; relatively easy; difficult; and failed. Difficult SE was encountered in 221 patients while failed SE was encountered in 205. A retrospective analysis of the criteria governing the difficulty of endoscopic SE following the index endoscopic intervention was performed to evaluate their significance in determining failure of complete SE among patients with difficult to extract bile duct stones. Results. Age ≥ 85 years, periampullary diverticula, multiple CBD stones (>4), and diameter of CBD stones (≥15 mm) were all significant contributing factors to a failed SE in univariate statistical tests. In the definitive multivariate analysis age, multiple stones and diameter of stones were found to be the significant, independent contributors. Conclusion. Failed conventional endoscopic stone clearance in patients with difficult to extract BDS is more likely to occur in overage patients, in patients with multiple CBD stones >4, and in patients with CBD stone(s) diameter ≥15 mm.

scholarly journals Retrospective comparative analysis of choledochoscopic bile duct exploration versus ERCP for bile duct stones

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Y. Al-Habbal ◽  
I. Reid ◽  
T. Tiang ◽  
N. Houli ◽  
B. Lai ◽  
...  
Keyword(s):  
Bile Duct ◽  
Clearance Rate ◽  
Operative Time ◽  
Time Data ◽  
Hospital Data ◽  
Open Conversion ◽  
Cbd Stones ◽  
Time To Recurrence ◽  
Metropolitan Hospital ◽  
Cbd Stone

Abstract Debate still exists for the management of choledocholithiasis. The purpose of this study is to quantify the rate of recurrent choledocholithiasis post choledochoscopic bile duct exploration (CBDE) in comparison to ERCP and sphincterotomy, and to demonstrate the feasibility of this approach in a busy metropolitan hospital. Data of patients undergoing CBDE from 2009–2014 at the Northern Hospital, Victoria, Australia, was collected retrospectively. Primary outcomes were bile duct clearance rate and rate of recurrent stones post-clearance. Secondary outcomes measured were post-operative complications, laparoscopic to open conversion rate and operative time. Data of patients undergoing ERCP at the same institution was collected and compared. In total, there were 4,091 cholecystectomy cases performed from 2009–2014, of which 260 (6.3%) of patients had an intraoperative cholangiography (IOC) indicating a common bile duct (CBD) stone. Two hundred and forty-eight patients (95.3%) had a CBDE. The remaining 12 patients (4.6%) had radiological clearance, which were excluded from the study. The overall clearance rate for patients undergoing CBDE was 84% (209/248). The risk of recurrent stones up to 8 years post clearance was 2% (4/209). In the same institution, and between 1998–2012, a total of 1,148 patients underwent ERCP, of which 571 had endoscopic sphincterotomy (ES). Forty-three patients required a repeat ERCP for recurrent CBD stones with a complication rate of 7.5%. Time to recurrence ranged from 6 months to 10 years with a mean of 4.5 years. The rate of recurrence was lower in the CBDE group compared to the patients who had an ERCP (8.9% vs. 2%). CBDE is a feasible and effective method for clearance of CBD stones at the time of laparoscopic cholecystectomy. This approach, although not widely used, reduces the need for ERCP, which has inherent complications. In the longer term, this series showed a significant reduction in the rate of CBD stone recurrence.

scholarly journals Extracorporeal Shockwave Lithotripsy with Tamsulosin in Clearance of Upper Ureteral Calculi- A Randomized Control Clinical Trial

2020 ◽  
Vol 23 (1) ◽  
pp. 36-42
Author(s):  
Md Safiul Alam Babul ◽  
Md Waliul Islam ◽  
Shariful Islam Khan ◽  
Mohammad Habibur Rahman ◽  
Anup Roy Chowdhury ◽  
...  
Keyword(s):  
Clearance Rate ◽  
Ureteral Stones ◽  
P Value ◽  
Ureteric Stone ◽  
Stone Size ◽  
Stone Clearance ◽  
Extracorporeal Shock Wave ◽  
Group A ◽  
Randomized Control ◽  
Group B

Background of the study: Urolithiasis has an incidence in the world of about 5% and the probability of a recurrence within 5–7 years is 50% (Parmar, 2004). Exact data about its prevalence is not known in Bangladesh but it is quite common as seen in outpatient department. It is more common in northern part of the country, male suffer more than female (M:F: 3:1) (Salam, 2002). Symptomatic ureteral calculi represent the most common condition encountered by an urologist in an emergency setting (Pak, 1998). Intervention is recommended for individuals with larger stones, especially greater than 5 mm (Kupeli et al., 1998). The treatment of this pathology was revolutionized with the introduction, in the late 1980s, of extracorporeal shock wave lithotripsy (ESWL), a non-invasive technology that has become one of the primary treatments for urinary stones. Its success rates vary depending on stone size and location and by the type of lithotripter employed. Medical expulsion therapy (MET) can play a key role in support of ESWL: specifically, expulsion is done by diuretics, calcium antagonists, anti-edema agents, and alpha-blockers. A few studies have reported their effectiveness (Borghi et al., 1994, Cervenakov et al., 2002, Porpiglia et al., 2002,Dellabella et al., 2003). Objective: This study is carried out to find out the role of Tamsulos in stone clearance in patientswith upper ureteral stone after extracorporeal shock wave lithotripsy (ESWL). Methods & Material: This randomized control clinical trialwas performed in Department of Urology, National Institute of Kidney Diseases and Urology, Sher-EBangla Nagar, Dhaka during the period from July 2015 to June 2017. A total of 70 cases with upper ureteric stone were included during the study period. Patients were selected randomly in every alternate sequence, odd numbers for experimental group, Tamsulosin+ ESWL, group A & even numbers for control group, only ESWL, group B. Stone clearance rate, number of ESWL session and stone expulsion time were evaluated. Results: In this study showed complete stone clearance one month after ESWL in Group A was 16(89%) and Group B was 16(84.21%) for stone size 6 to 10 mm. Comparison of clearance rate between two groups in stone size 6 to 10 mm was not statistically significant (p value >.05). Complete stone clearance one month after ESWL in Group A was 13(76%) and Group B was 07(43.75%) for stone size 11 to 15 mm. Comparison of clearance rate between two groups in stone size 11 to 15 mm was statistically significant (p value <.05). In this study requirement of number of ESWL sessions according to the stone size showed, in case of 6 to 10 mm stone size, average ESWL sessions 1.28±0.5 in Group A and 1.53±0.7 in Group B and in case of 11to 15 mm stone size, average ESWL sessions 1.29±0.5 in Group A and 1.62±0.7 in Group B. Comparison of ESWL sessions between two groups were statistically significant (p value <.05). In this study mean expulsion time of stone in Group A was 22.34±12.23 days and in Group B was 32.34±21.96 days. Comparison of stone expulsion time between two groups were statistically significant (p value <.05). Conclusion: Tamsulosin results in increased stone-free rates and in lower percentages of patients requiring re-treatment. Tamsulosin can be self-administered and can play a key role in the choice between tamsulosin after ESWL and only ESWL for upper ureteric stone disease treatment. Use of tamsulosin makes the expulsive medical therapy suitable for improving overall outcomes of ESWL treatment for upper ureteral stones. Tamsulosin helps in clearance of upper ureteral stones after ESWL. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.36-42

Therapeutic Images of CT Image Analysis Based on 3D Visualization Technology in Patients with Hepatobiliary Stones

2020 ◽  
Vol 10 (9) ◽  
pp. 2101-2105
Author(s):  
Jingqin Cao ◽  
Defen Zhang ◽  
Yanxiao Yue ◽  
Yingchun Zhang ◽  
Huaizhuang Cai ◽  
...  
Keyword(s):  
Bile Duct ◽  
Blood Transfusion ◽  
Clearance Rate ◽  
Preoperative Planning ◽  
3D Visualization ◽  
Three Dimensional ◽  
Bile Duct Stones ◽  
Stone Clearance ◽  
Visualization Technology ◽  
Model Visualization

Objective: Paper for CT imaging in three-dimensional visualization technology for laparoscopy combined with biliary hard lens therapeutic clinical effect of extrahepatic bile duct stones were evaluated. Methods: Abdominal medical image 3D visualization software for our hospital CT imaging diagnosis and treatment of bile duct stones in 45 patients of bile duct stones three-dimensional visualization of clinical analysis and preoperative planning, and brought it into the operating room three-dimensional visualization model, guiding the implementation of the joint 3D laparoscopic biliary lithotripsy targeted hard lens. At the same time, as well as consistency with the actual hepatolithiasis distribution calculation operative 3D model visualization display; The operative time, bleeding, blood transfusion, stone clearance rate, morbidity and mortality perioperative after review stone recurrence rate was observed. Results: reproducing a three-dimensional patient model visualization liver, intrahepatic vascular anatomy of the liver bile duct stones distributed, real intraoperative and preoperative displayed three-dimensional visualization model consistent, pre-operative manner consistent with preoperative planning. Operation time (125.9±21.2) minutes, blood loss (38.8±8.5) ml, no massive hemorrhage and blood transfusion; MRCP examination by stone clearance rate was 100%; 2 biliary injury, bile leakage 1 complication the rate was 6.7%; There were no perioperative deaths. Stone recurrence two cases, the recurrence rate of 4.4%. Conclusion: The three-dimensional visualization techniques may be implemented hepatolithiasis accurate assessment of preoperative, intraoperative guidance of laparoscopic, endoscopic biliary hard gravel, stone liver resection operation, help to improve stone clearance rate, guarantee operation safety.

scholarly journals Outcome of Percutaneous Nephrolithotomy in the Management of Lower Pole Stones

2018 ◽  
Vol 16 (3) ◽  
pp. 274-278
Author(s):  
Udaya Man Singh Dongol ◽  
Sandeep Bohora
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Clearance Rate ◽  
Operating Time ◽  
Lower Pole ◽  
Stone Size ◽  
Stone Clearance ◽  
Minimally Invasive Surgical ◽  
The Mean ◽  
Complications Rate

Background:  Urolithiasis is a worldwide problem  due to its high prevalence and  recurrence. Percutaneous nephrolithotomy is a minimally invasive surgical option for the treatment of large renal stone burden greater than 20mm, staghorn calculi and lower pole calyceal stone greater than 10 mm. The objective of this study was to evaluate the safety and  efficacy of percutaneous nephrolithotomy in the management of lower pole calyceal stones.Methods: Seventy  patients who presented in between June 2013 and September 2017 with  lower pole calyceal stones and lower calyceal stones with pelvic extension  were included in the study. The  operating time, the hospital stay, complications rate, stone clearance rate were all noted. Patients were followed up in three and six weeks with X-ray KUB and ultrasonography of abdomen.Results: Seventy adult patients with lower pole calyceal stones underwent standard percutaneous nephrolithotomy. The mean age was 32 years (18-71 yrs). The mean stone size was 17.6 mm (15 –28 mm). The mean operating time was 62 minutes (48-124 mins) and hospital stay was 4.1 days(4-8 days). The stone clearance rate was 92.6% for stone <20mm and 90.7% stone size >20 mm. The complications noted were fever (8.5%), transient haematuria (20%), urine leak (5.7%), obstruction by residual fragments (5.7%) and one pseudoaneurysm(1.42%). Seven patients (10%) needed blood transfusion.Conclusions: Percutaneous nephrolithotomy is a safe, feasible and highly effective method for the treatment of lower pole calyceal stones.

scholarly journals Trends in Renal Stone Clearance after Ureteroscopy: A Review

2019 ◽  
Vol 2 (4) ◽  
pp. e44-e50
Author(s):  
Subiksha Subramonian ◽  
Somasundari Gopalakrishnan ◽  
Yuko Smith
Keyword(s):  
Ct Scan ◽  
Clearance Rate ◽  
Holmium Laser ◽  
Clearance Rates ◽  
Stone Size ◽  
Stone Clearance ◽  
X Ray ◽  
Stone Free Rate ◽  
Free Rate ◽  
Over Time

Background and ObjectivesStone clearance rate in ureteroscopy has varied over the years. This study aims to review the stone clear-ance rate over the last 25 years and assess the change over time. We have analyzed the reasons for the peaks and troughs in stone clearance rate to see if it correlates with any factors such as the introduction of new technology like the holmium laser, flexible ureteroscopy, access sheaths, and digital ureteroscopy. Material and MethodsWe performed a PubMed search (August 2019) for papers including the terms “lithiasis”, “stone clear-ance”, “calculi”, “kidney stone”, “ureteric stone”, “ureteroscopy”, “holmium laser”, “retrorenal surgery” in their title and published between the years 1994 and 2019. The stone size, stone clearance rate and mode of imaging to determine clearance rates were recorded. For data analysis, only prospective studies with a minimum of 50 patients and ureteroscopy arm of prospective randomized controlled trials were included. ResultsWe reviewed 16 papers with a total of 1,689 patients with renal stones. Average stone clearance was 80% and the median stone size was 11.0mm. Stone clearance was determined by either: Computed tomography (CT) scan (8 studies), x-ray alone (3 studies), x-ray and ultrasound (3 studies) or not mentioned (2 studies). CT scan yielded lower stone clearance rates than x-ray due to the increased detail shown on CT. For studies that used absolute clearance with no residual stones, average clearance was 52%, and this stone clearance rate increased as the cut-off size used to determine the stone-free rate was increased.ConclusionThis study highlights that stone clearance rate after ureteroscopy varies significantly amongst different pa-pers because of the stone size used to define ‘stone-free rate’ and the method of imaging used to determine stone clearance. The study also shows that stone clearance rates have not improved significantly over time, despite the introduction of advances in technology.

scholarly journals Application of digital cholangioscopy assisted non-radiation endoscopic retrieval of common bile duct stones

2020 ◽  
Author(s):  
Yadong Feng ◽  
Wei Xu ◽  
Yang Liu ◽  
Xiaomei Sun ◽  
Yan Liang ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Common Bile Duct Stones ◽  
Bile Leakage ◽  
Laser Lithotripsy ◽  
Technical Success ◽  
Stone Clearance ◽  
Cbd Stones ◽  
Endoscopic Retrieval ◽  
Technical Details

Abstract Background Few studies have evaluated digital cholangioscopy (DCS) assisted non-radiation endoscopic retrograde cholangiopancreatography (NR-ERCP) for choledocholithiasis. Here, we evaluated the application of DCS assisted NR-ERCP for endoscopic retrieval of common bile duct (CBD) stones.Methods Patients who underwent ERCP for choledocholithiasis and without prior ERCP were included. Data related to technical success and outcomes of DCS-assisted NR-ERCP and conventional ERCP were retrieved and compared. Procedure and technical details of DCS assisted NR-ERCP were collated and reviewed.Results In total, 304 and 53 patients who underwent conventional and DCS-assisted ERCP were recruited. Relatively larger stones (p < 0.001) was present in DCS assisted NR-ERCP. No statistical difference was present in biliary access, lithotripsy, stone removal and total complications. A higher proportion of larger balloon for EPBD (p < 0.001) and more ERCP sessions for stone clearance (p < 0.001) were present in conventional ERCP. In DCS-assisted ERCP, technical success was achieved in 52 (98.1%) patients and DCS-guided laser lithotripsy was applied in 9 (17%) patients. DCS guided laser lithotripsy was superior to mechanical lithotripsy for stone clearance (p < 0.001) in large stones. Mean length of biliary exploration and whole NR-ERCP were 8.60 ± 1.96 (6–19) and 32.96 ± 16.29 (13–82) minutes, respectively. One delayed bile-leakage, one moderate pancreatitis, two mild pancreatitis and five cases of hyperamylasemia occurred. Technical details and complications were not statistically differed between patients with a dilated and a non-dilated CBD.Conclusions DCS-based NR-ERCP is technically feasible and safe for retrieval of CBD stones. It provides an alternative to conventional ERCP for endoscopic treatment of simple choledocholithiasis.

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