Efficacy
                    and safety of novel digital single-operator peroral cholangioscopy-guided laser
                    lithotripsy for complicated biliary stones

Abstract Background/study aims Laser lithotripsy can effectively fragment complicated biliary stones, but current cholangioscopes are limited by fragility, restricted mobility or moderate visual resolution. The efficacy and safety of a new digital single-operator peroral cholangioscope to guide laser lithotripsy were evaluated. Patients and methods In this prospective single-center series, consecutive patients with complicated biliary stones, defined as impacted stones > 1.5 cm in size and wider than the more distal common bile duct, or stones that failed extraction by basket mechanical lithotripsy, underwent ERCP and SpyGlass DS peroral cholangioscope (Boston Scientific, Marlborough, United States)-guided laser lithotripsy. Stone clearance rate and incidence of adverse events were determined. Results Seventeen patients (10 men, 7 women; median age 76 years) with a median biliary stone size of 2 cm underwent predominantly holmium:yttrium aluminum garnet laser lithotripsy, achieving a 94 % stone clearance rate over 1 median procedure. Lithotripsy was performed in 8 of 17 patients due to an impacted biliary stone. The remaining patients underwent lithotripsy due to prior failure of the basket mechanical lithotripter to capture or crush their stones. Post lithotripsy, 2 patients developed cholangitis and 1 patient with underlying COPD developed respiratory distress, all resolved with conservative management. There were no hemobilia, perforations, pancreatitis nor any deaths. Conclusion SpyGlass DS peroral cholangioscopy-guided laser lithotripsy is an efficient and safe modality for management of complicated biliary stones.

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Efficacy and safety of peroral cholangioscopy with intraductal lithotripsy for difficult biliary stones: a systematic review and meta-analysis

Endoscopy ◽

10.1055/a-1200-8064 ◽

2020 ◽

Author(s):

Thomas R. McCarty ◽

Rishabh Gulati ◽

Tarun Rustagi

Keyword(s):

Adverse Events ◽

Meta Analysis ◽

Laser Lithotripsy ◽

Efficacy And Safety ◽

Procedure Time ◽

Single Session ◽

Biliary Stones ◽

Peroral Cholangioscopy ◽

Stone Fragmentation ◽

Fragmentation Rate

Abstract Background Peroral cholangioscopy with intraductal lithotripsy facilitates optically guided stone fragmentation of difficult biliary stones refractory to conventional endoscopic therapy. The aim of this study was to evaluate the efficacy and safety of peroral cholangioscopy with intraductal lithotripsy for difficult biliary stones. Methods Searches of PubMed, EMBASE, Web of Science, and Cochrane databases were performed in accordance with PRISMA and MOOSE guidelines. Measured outcomes included overall fragmentation success, single-session fragmentation and duct clearance, and rate of adverse events. Sensitivity and subgroup analyses were performed based upon cholangioscopy technique and type of lithotripsy (laser versus electrohydraulic). Heterogeneity was assessed with I 2 statistics. Publication bias was ascertained by funnel plot and Egger regression testing. Results 35 studies were included with 1762 participants (43.4 % men; mean age 61.5 [standard deviation (SD) 11.0]). Prior cholecystectomy had been performed in 37 % of patients, with a mean number of 1.6 (SD 0.5) ERCPs performed prior to lithotripsy. Mean stone size was 1.8 (SD 0.3) cm. Peroral cholangioscopy with intraductal lithotripsy achieved an overall stone fragmentation success of 91.2 % (95 %CI 88.1 % – 93.6 %; I 2 = 63.2 %) with an average of 1.3 [SD 0.6] lithotripsy sessions performed. Complete single-session fragmentation success was 76.9 % (95 %CI 71.6 % – 81.4 %; I 2 = 74.3 %). The adverse events rate was 8.9 % (95 %CI 6.5 % – 12.2 %; I 2 = 60.6 %). Mean procedure time for peroral cholangioscopy was 67.1 (SD 21.4) minutes. There was no difference in overall fragmentation rate or adverse events; however, laser lithotripsy was associated with a higher single-session fragmentation rate and shorter procedure time compared with electrohydraulic lithotripsy. Conclusions Peroral cholangioscopy with intraductal lithotripsy appears to be a relatively safe and effective modality for difficult biliary stones.

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Su1545 SINGLE-OPERATOR PERORAL CHOLANGIOSCOPY-GUIDED LITHOTRIPSY FOR DIFFICULT BILIARY STONES - A PROSPECTIVE MULTICENTER STUDY

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2020.03.2391 ◽

2020 ◽

Vol 91 (6) ◽

pp. AB373

Author(s):

João Fernandes ◽

Marta Moreira ◽

Dalila Costa ◽

Gonçalo Alexandrino ◽

Tarcísio Araújo ◽

...

Keyword(s):

Multicenter Study ◽

Biliary Stones ◽

Prospective Multicenter Study ◽

Peroral Cholangioscopy ◽

Single Operator

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MANAGEMENT OF COMPLICATED BILIARY STONES USING SPYGLASS DS PER-ORAL CHOLANGIOSCOPY-GUIDED LASER LITHOTRIPSY

10.1055/s-0038-1637635 ◽

2018 ◽

Author(s):

P Soriani ◽

V Giorgio Mirante ◽

C Barbera ◽

T Gabbani ◽

L Miglioli ◽

...

Keyword(s):

Laser Lithotripsy ◽

Biliary Stones ◽

Spyglass Ds ◽

Per Oral

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Efficacy and Safety of Digital Single-Operator Cholangioscopy in the Diagnosis of Indeterminate Biliary Strictures by Targeted Biopsies: A Systematic Review and Meta-Analysis

Diagnostics ◽

10.3390/diagnostics10090666 ◽

2020 ◽

Vol 10 (9) ◽

pp. 666

Author(s):

Li-Jia Wen ◽

Jun-Hong Chen ◽

Hong-Ji Xu ◽

Qiong Yu ◽

Kai Liu

Keyword(s):

Likelihood Ratio ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Optimal Number ◽

Adverse Event Rate ◽

Cochrane Library ◽

Efficacy And Safety ◽

Biliary Strictures ◽

Single Operator ◽

Spyglass Ds

Background: Biliary strictures are frequently encountered in clinical practice. The determination of their nature is often difficult. This study aims to systematically evaluate the efficacy and safety of the second generation of digital single-operator cholangioscopy (SpyGlass DS, DSOC) in indeterminate biliary strictures (IBDS) through biopsies. Methods: All relative studies published in Medline, the Cochrane Library, Web of Science, and EMBASE were included. The diagnostic tests for IBDS were compared to the surgical histology, autopsy, or long-term clinical follow-up. The methodological quality of the included studies was evaluated by the Quality Assessment of Studies of Diagnostic Accuracy Included in Systematic Reviews (QUADAS-2). Results: A total of 11 studies, which involved 356 patients diagnosed through biopsies, were included. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were 0.74 (95% CI: 0.67–0.80), 0.98 (95% CI: 0.95–1.00), 10.52 (95% CI: 5.45–20.32), 0.31 (95% CI: 0.23–0.41), and 65.18 (95% CI: 26.79–158.61), respectively. The area under the curve (AUC) was 0.9479, and the pooled adverse event rate was 7%. The sensitivity and specificity in the heterogeneity analysis were I2 = 48.1% and I2 = 25.4%, respectively. Conclusion: SpyGlass DS is a safe and effective technique for IBDS. However, future randomized trials are needed to determine optimal number of biopsies.

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Holmium-YAG Laser Lithotripsy in the Treatment of Difficult Biliary Stones Utilizing Peroral Single Operator Cholangioscopy (SPYGLASS): A Multi-Center Experience

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2009.03.210 ◽

2009 ◽

Vol 69 (5) ◽

pp. AB142 ◽

Cited By ~ 4

Author(s):

Sandeep Patel ◽

Laura Rosenkranz ◽

Paul R. Tarnasky ◽

Isaac Raijman ◽

Douglas S. Fishman ◽

...

Keyword(s):

Laser Lithotripsy ◽

Biliary Stones ◽

Yag Laser ◽

Single Operator

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Peroral Cholangioscopy (PO) Using a Disposable Steerable Single Operator Catheter for Biliary Stone Therapy and Assessment of Indeterminate Strictures - A Multi-Center Experience Using Spyglass

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2008.03.125 ◽

2008 ◽

Vol 67 (5) ◽

pp. AB103 ◽

Cited By ~ 8

Author(s):

Yang K. Chen ◽

Mansour a. Parsi ◽

Kenneth F. Binmoeller ◽

Robert H. Hawes ◽

Douglas Pleskow ◽

...

Keyword(s):

Biliary Stone ◽

Peroral Cholangioscopy ◽

Single Operator

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IDDF2018-ABS-0144 Single-operator peroral cholangioscopy in the treatment of difficult biliary stones: a systematic review and meta-analysis

10.1136/gutjnl-2018-iddfabstracts.220 ◽

2018 ◽

Author(s):

Zheng Jin ◽

Xiaofeng Zhang

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Biliary Stones ◽

Peroral Cholangioscopy ◽

Single Operator

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Single-operator holmium laser lithotripsy under direct peroral cholangioscopy using an ultra-slim upper endoscope in a patient with a large stone in the common bile duct

The Turkish Journal of Gastroenterology ◽

10.5152/tjg.2017.17111 ◽

2017 ◽

Vol 28 (6) ◽

pp. 505-509 ◽

Cited By ~ 1

Author(s):

Roberto Di Mitri ◽

Filippo Mocciaro

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Laser Lithotripsy ◽

Holmium Laser ◽

Peroral Cholangioscopy ◽

Large Stone ◽

Holmium Laser Lithotripsy ◽

Single Operator ◽

The Common ◽

Direct Peroral Cholangioscopy

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Peroral Cholangioscopy (POC) Using a Disposable Steerable Single Operator Catheter for Biliary Stone Therapy and Assessment of Indeterminate Strictures - A Multi-Center Experience Using SPYGLASS

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2009.03.695 ◽

2009 ◽

Vol 69 (5) ◽

pp. AB264-AB265 ◽

Cited By ~ 13

Author(s):

Yang K. Chen ◽

Mansour A. Parsi ◽

Kenneth F. Binmoeller ◽

Robert Hawes ◽

Douglas K. Pleskow ◽

...

Keyword(s):

Biliary Stone ◽

Peroral Cholangioscopy ◽

Single Operator

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

Endoscopy ◽

10.1055/a-0848-8373 ◽

2019 ◽

Vol 51 (11) ◽

pp. 1066-1073 ◽

Cited By ~ 1

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.

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