Intelligent difficulty scoring and assistance system for endoscopic extraction of common bile duct stones based on deep learning: multicenter study

Endoscopy ◽  
2020 ◽  
Author(s):  
Li Huang ◽  
Xiaoyan Lu ◽  
Xu Huang ◽  
Xiaoping Zou ◽  
Lianlian Wu ◽  
...  
Keyword(s):  
Deep Learning ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Balloon Dilation ◽  
Technical Difficulty ◽  
Assistance System ◽  
Stone Clearance ◽  
Cbd Stones ◽  
Endoscopic Extraction ◽  
Cbd Stone

Abstract Background The study aimed to construct an intelligent difficulty scoring and assistance system (DSAS) for endoscopic retrograde cholangiopancreatography (ERCP) treatment of common bile duct (CBD) stones. Methods 1954 cholangiograms were collected from three hospitals for training and testing the DSAS. The D-LinkNet34 and U-Net were adopted to segment the CBD, stones, and duodenoscope. Based on the segmentation results, the stone size, distal CBD diameter, distal CBD arm, and distal CBD angulation were estimated. The performance of segmentation and estimation was assessed by mean intersection over union (mIoU) and average relative error. A technical difficulty scoring scale, which was used for assessing the technical difficulty of CBD stone removal, was developed and validated. We also analyzed the relationship between scores evaluated by the DSAS and clinical indicators including stone clearance rate and need for endoscopic papillary large-balloon dilation (EPLBD) and lithotripsy. Results The mIoU values of the stone, CBD, and duodenoscope segmentation were 68.35 %, 86.42 %, and 95.85 %, respectively. The estimation performance of the DSAS was superior to nonexpert endoscopists. In addition, the technical difficulty scoring performance of the DSAS was more consistent with expert endoscopists than two nonexpert endoscopists. A DSAS assessment score ≥ 2 was correlated with lower stone clearance rates and more frequent EPLBD. Conclusions An intelligent DSAS based on deep learning was developed. The DSAS could assist endoscopists by automatically scoring the technical difficulty of CBD stone extraction, and guiding the choice of therapeutic approach and appropriate accessories during ERCP.

scholarly journals Direct Peroral Cholangioscopy in the Management of Difficult Biliary Stones: a New Tool to Confirm Common Bile Duct Clearance. Results of a Preliminary Study

2019 ◽  
Vol 28 (1) ◽  
pp. 89-94
Author(s):  
Andrea Anderloni ◽  
Francesco Auriemma ◽  
Alessandro Fugazza ◽  
Edoardo Troncone ◽  
Luis Maia ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Balloon Dilation ◽  
Biliary Stones ◽  
Serious Adverse Events ◽  
Endoscopic Techniques ◽  
Cbd Stones ◽  
Large Bile Duct ◽  
Cbd Stone ◽  
Per Oral

Background & Aims: Endoscopic sphincterotomy (ES) with stone extraction is the standard treatment for choledocholithiasis. After stone retrieval, balloon-occluded cholangiography is generally performed to confirm bile duct clearance but can miss residual stones particularly in patients with residual small-sized stones, a large bile duct or pneumobilia. In addition, difficult common bile duct (CBD) stones requiring advanced endoscopic techniques for retrieval are a potential risk factor for choledocholithiasis recurrence.Methods: We performed a retrospective evaluation of a prospectively maintained procedures database. From July 2016 to December 2017, all patients with difficult CBD stones who underwent endoscopic retrograde cholangiopancreatography (ERCP) with papillary balloon dilation-assisted stone retrieval and subsequent direct per-oral cholangioscopy (DPOC) using standard gastroscopes to confirm CBD clearance were analyzed.Results: Thirty-six patients who underwent ERCP and DPOC were included. Technical success, defined as deep intubation of CBD with hepatic hilum visualization, was achieved in 31 of 36 patients (86%). During DPOC, residual CBD stones were visualized and removed in 7 of 31 patients (22.5%). After a mean of 241 ± 56 days of follow-up post-DPOC, no serious adverse events were reported, and there was no evidence orsuspicion of recurrent choledocholithiasis.Conclusions: Direct per-oral cholangioscopy immediately following difficult CBD stone removal was safe, feasible and accurate. In this setting, DPOC at the time of ERCP appears to be a very useful tool to achieve complete clearance of choledocholithiasis.

EFFICACY OF ERCP WITH SPHINCTEROTOMY OR PAPILLARY BALLOON DILATION IN THE CBD STONES THERAPY

2014 ◽  
pp. 19-23
Author(s):  
Van Huy Tran ◽  
Trung Nam Phan ◽  
Khanh Vinh ◽  
Minh Tan Le ◽  
Yamamoto Kenta ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Balloon Dilation ◽  
Stone Disease ◽  
Routine Procedure ◽  
Endoscopic Retrograde ◽  
Cbd Stones ◽  
Biliary Sphincterotomy ◽  
Cbd Stone ◽  
Ballon Dilation

Background: Common bile duct (CBD) stone is the disease which leads to more severe complications than other cholelithiasis. The last 30 years have seen major developments in the management of CBD stone disease. Endoscopic retrograde cholangiopancreatography (ERCP) has become a widely available and routine procedure. The effect of this therapy is affected by patient’s condition, number, size and site of CBD stone… Aim: To evaluate the results and complications of ERCP in common bile duct (CBD) stones. Patients/Methods: Between 9/2010 and 12/2013, 42 CBD stone patients were included. According to the protocol, we treated, followed up and assessed the success rate, complication rate of ERCP combine with oddi sphincterotomy or papillary ballon dilation. Results: The successful rate of biliary stone removal was 95.2%. The rate of complication was 9.5%. Pancreatitis is common complications (7.1%). Conclusion: ERCP combine with oddi sphincterotomy or papillary ballon dilation is an effective and relatively safe therapy for CBD stones. Keywords: common bile duct stone, ERCP, Biliary sphincterotomy.

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 Pre-operative MRCP: is it necessary before routine laparoscopic cholecystectomy to exclude CBD stone-prospective study in tertiary care hospital

2017 ◽  
Vol 4 (11) ◽  
pp. 3633 ◽  
Author(s):  
Ganni Bhaskara Rao ◽  
Samir Ranjan Nayak ◽  
Sepuri Bala Ravi Teja ◽  
Reshma Palacharla
Keyword(s):  
Patient Safety ◽  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Liver Function ◽  
Liver Function Test ◽  
Ultrasound Examination ◽  
Cbd Stones ◽  
Function Test ◽  
Cbd Stone

Background: Cholelithiasis is a common disease and at present the laparoscopic cholecystectomy is the gold standard treatment. The diagnosis of associated common bile duct stone for patients with gallstones is important for prompt surgical decision, treatment efficacy and patient safety. However, whether upper abdominal ultrasound and Liver function test (LFT) is adequate before doing lap cholecystectomy remains controversial. There are different opinions regarding the routine magnetic resonance cholangiopancreatography (MRCP) to detect the possible presence of common bile duct (CBD) stones before laparoscopic cholecystectomy.Methods: This study was carried on a total of 106 patients who were admitted and treated for gall stone diseases in the Department of General Surgery, GSL General Hospital over a period of 24 months. After admission all cases were subjected for liver function test, USG abdomen and MRCP. The collected observational data was analyzed.Results: Among the 106 patients, a total of 17cases showed concurrent gallstones and choledocholithiasis, 11 cases choledocholithiasis were revealed by ultrasound examination, while 6 cases of choledocholithiasis were not detected by ultrasound examination but were confirmed by MRCP.Conclusions: CBD stone may be missed even in the presence of deranged liver enzymes or dilated CBD in USG abdomen. Hence for patient safety routine preoperative MRCP examination is recommended before doing laparoscopic cholecystectomy to rule out the likelihood of concomitant CBD stones. The cost-effectiveness of such expensive investigation is to be studied further taking into consideration preventive costs and patient morbidity and mortality.

scholarly journals P-BN39 The perils of MRCP requesting and early associations of data quality and likelihood of a diagnostic result

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Callum Jones ◽  
Helena Barton ◽  
Samir Pathak ◽  
Jonathan Rees
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Expectant Management ◽  
Clinical Information ◽  
Common Bile Duct Stones ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Biliary Tree ◽  
Cbd Stones ◽  
Optimal Information ◽  
Cbd Stone

Abstract Background MRCP (Magnetic resonance cholangiopancreatography) is used most to assess the biliary tree for stones or strictures. Recently, MRCP availability has increased, and it is extensively used to detect of common bile duct (CBD)stones although very frequently no stones are seen. Indeed, the currently recruiting sunflower RCT aims to determine the clinical and cost effectiveness of expectant management versus MRCP in patients undergoing laparoscopic cholecystectomy at low or moderate risk of common bile duct stones. However, it is critical when requesting an investigation that adequate information is provided.  This work aimed, to describe the adequacy of information provided and correlate this with the MRCP result. We hypothesised that the less information that was provided the more common a normal result would be. Methods For a three month period (January 2021 to April 2021) all MRCP requests to detect the presence of a CBD stone were reviewed and data obtained from the Radiology CRIS (CDN Radiology Information System, CDN, Sydney, Aus.). The requesting information was compared to three pre-defined criteria (CBD diameter, presence of gallstones and LFT details) that were agreed as the optimal information that a reporting radiologist would require. The number of key pieces of information for each request and whether the request identified a CBD stone were identified. The proportion of MRCPs detecting a CBD stone was calculated according to the number of key pieces of information provided.     Results 56 patients were identified, of which 16 (29%) patients had CBD stones. In 24/56 (43%) patients the presence of gallstones on a previous ultrasound was provided, 14/56 (25%) of patients had information about LFTs including bilirubin and a trend in LFTs was not stated for any patient (0/56; 0%).  The rate of stone detection was calculated by the number of pieces of information provided. The rate was 71% (5/7) when all 3 pieces of data were provided, 31% (2/13) when two piece of information were provided, 30% (8/27) when a single piece of information was provided, and only 11% (1/11) when none of the specified data were provided. Conclusions It is uncommon for adequate clinical information to be provided in MRCP requests and in 16% of request no key information was provided. The LFT results were frequently omitted and the trend in LFTs never stated. The more key data provided in the request saw a higher proportion of MRCPs where a CBD stone was identified. We recommend that maximal clinical information is mandated for MRCP request perhaps using mandatory fields on electronic requesting systems and that  these systems are also used to facilitate recruitment to clinical trials such the Sunflower RCT.

scholarly journals Increased Prevalence of Subclinical Hypothyroidism in Common Bile Duct Stone Patients

2007 ◽  
Vol 92 (11) ◽  
pp. 4260-4264 ◽  
Author(s):  
Johanna Laukkarinen ◽  
Gediminas Kiudelis ◽  
Marko Lempinen ◽  
Sari Räty ◽  
Hanna Pelli ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Subclinical Hypothyroidism ◽  
Sphincter Of Oddi ◽  
Liver Function Tests ◽  
Control Group ◽  
Cbd Stones ◽  
History Of ◽  
Cbd Stone ◽  
Previous Medical History

Abstract Context: Earlier, we have shown an increased prevalence of previously diagnosed hypothyroidism in common bile duct (CBD) stone patients and a delayed emptying of the biliary tract in hypothyroidism, explained partly by the missing prorelaxing effect of T4 on the sphincter of Oddi contractility. Objective: In this study, the prevalence of previously undiagnosed subclinical hypothyroidism in CBD stone patients was compared with nongallstone controls. Patients: All patients were clinically euthyreotic and without a history of thyroid function abnormalities. CBD stones were diagnosed at endoscopic retrograde cholangiopancreatography (group 1; n = 303) or ruled out by previous medical history, liver function tests, and ultrasonography (control group II; n = 142). Main Outcome Measures: Serum free FT4 and TSH (S-TSH) were analyzed; S-TSH above the normal range (>6.0 mU/liter) was considered as subclinical and S-TSH 5.0–6.0 mU/liter as borderline-subclinical hypothyroidism. Results: A total of 5.3 and 5.0% (total 10.2%; 31 of 303) of the CBD stone patients were diagnosed to have subclinical and borderline-subclinical hypothyroidism, compared with 1.4% (P = 0.05) and 1.4% (total 2.8%, four of 142; P = 0.026) in the control group, respectively. In women older than 60 yr, the prevalence of subclinical hypothyroidism was 11.4% in CBD stone and 1.8% in control patients (P = 0.032) and subclinical plus borderline-subclinical hypothyroidism 23.8% in CBD stone and 1.8% in control patients (P = 0.012). Conclusion: Subclinical hypothyroidism is more common in the CBD stone patients, compared with nongallstone controls, supporting our hypothesis that hypothyroidism might play a role in the forming of CBD stones. At minimum, women older than 60 yr with CBD stones should be screened for borderline or overt subclinical hypothyroidism.

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 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.

scholarly journals One-stage lapro-endoscopic procedure in the management of concomitant gallbladder and common bile duct stones: institutional experience

2019 ◽  
Vol 6 (5) ◽  
pp. 1447
Author(s):  
Ahmed M. Abdelaziz Hassan ◽  
Ayman M. Abdelaziz ◽  
Mohamed Emad Esmat ◽  
Hussam Hamdy ◽  
Magdy M. Elsebae
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Gallstone Disease ◽  
Operating Time ◽  
Common Bile Duct Stones ◽  
Biliary Duct ◽  
Bile Duct Stones ◽  
Stone Clearance ◽  
One Stage ◽  
Cbd Stone

Background: Still there is no standard technique for managing patients with concomitant gallbladder (GB) and common bile duct stones (CBDS). In this work, we report our experience of the management for gallstone disease and biliary duct calculi as a single stage treatment.Methods: Forty Patients with symptomatic gall bladder calcular disease and suspected CBDS were enrolled in the study. The outcome measures were operating time, CBD stone clearance, postoperative morbidity and mortality, the need to conversion to other techniques and hospital stay.Results: They were 13 males and 27 females of median age 43 years old. Intra opertative cholangiography (IOC) revealed single CBD stone in twenty-eight, two stones in eleven and three stones in only one of the patients. The mean operating time had been 175 min. There were no intraoperative complications with a mean hospital stay was 1.8 days (range, 1-4 days).Conclusions: One-stage lapro-endoscopic procedure in the management for gallstone disease and biliary duct calculi is safe and efficient in CBD stone clearance. It is preferred when facilities and experience in endoscopic therapy exist.

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