scholarly journals Primary endoscopic bile duct stone removal for severe acute cholangitis: a retrospective study

2021 ◽  
Vol 14 ◽  
pp. 263177452110440
Author(s):  
Yu Ishii ◽  
Akihiro Nakayama ◽  
Kei Nakatani ◽  
Shigetoshi Nishihara ◽  
Shu Oikawa ◽  
...  
Keyword(s):  
Bile Duct ◽  
Acute Cholangitis ◽  
Primary Group ◽  
Gallstone Pancreatitis ◽  
Bile Duct Stones ◽  
Endoscopic Nasobiliary Drainage ◽  
Bile Duct Stenosis ◽  
Stone Removal ◽  
Hospitalization Period ◽  
Elective Group

Introduction: While the Tokyo Guidelines 2018 suggest primary stone removal for mild to moderate cholangitis, a guideline for severe acute cholangitis is not mentioned. We, therefore, investigated the clinical outcomes of patients with severe acute cholangitis to confirm the usefulness and safety of primary stone removal. Method: This study included 104 severe acute cholangitis patients without gallstone pancreatitis diagnosed at our institution between January 2014 and December 2020. Patients with percutaneous transhepatic biliary drainage as the primary drainage, bile duct stenosis, and endoscopically unidentified bile duct stones were excluded from this study. The clinical results of 14 patients with primary stone removal (primary group) and 23 patients with elective stone removal (elective group) were then retrospectively examined (excluding abnormal values due to underlying diseases). Results: Upon comparing the patient characteristics between groups, the elective group had significantly higher cardiovascular dysfunction (57% vs 7%; p = 0.004), septic shock (39% vs 0%; p = 0.006), disseminated intravascular coagulation treatment (57% vs 14%; p = 0.016), and positive blood cultures (91% vs 43%; p = 0.006) than those in the primary group. Endoscopic sphincterotomy for naïve papilla (90% vs 21%; p = 0.01) and endoscopic nasobiliary drainage (50% vs 9%; p = 0.014) were higher in the primary group, while endoscopic biliary stenting (7% vs 87%; p < 0.001) was lower than that in the elective group. Discussion: There were no significant differences in adverse events or complete stone removal rates between the two groups. In the primary group, the period from the first endoscopic retrograde cholangiopancreatography to stone removal (0 days vs 12 days; p < 0.001) and hospitalization period (12 days vs 26 days; p = 0.012) were significantly shorter and the hospitalization cost ($7731 vs $18758; p < 0.001) was significantly lower than those in the elective group. Conclusion: If patients are appropriately selected, bile duct stones may be safely removed for the treatment of severe acute cholangitis.

scholarly journals Endoscopic laser lithotripsy for complicated bile duct stones: is cholangioscopic guidance necessary?

2007 ◽  
Vol 44 (2) ◽  
pp. 137-140 ◽  
Author(s):  
Ralf Jakobs ◽  
Julio C. Pereira-Lima ◽  
Aline W. Schuch ◽  
Lucas F. Pereira-Lima ◽  
Axel Eickhoff ◽  
...  
Keyword(s):  
Bile Duct ◽  
Laser Lithotripsy ◽  
Bile Duct Stones ◽  
Distal Bile Duct ◽  
Laser Guidance ◽  
Endoscopic Papillotomy ◽  
Intrahepatic Stones ◽  
Bile Duct Stenosis ◽  
Extracorporeal Shock Wave ◽  
Fluoroscopic Control

BACKGROUND: Endoscopic papillotomy is successful in more than 95% of the cases of choledocholithiasis. For patients with difficult bile duct stones not responding to mechanical lithotripsy, different methods for stone fragmentation have been developed. AIM: To compare the results of laser lithotripsy with a stone-tissue recognizing system, when guided by fluoroscopy only or by cholangioscopy. METHODS: Between 1992 and 2002 we have treated 89 patients with difficult bile duct stones by endoscopic retrograde cholangiopancreatography and laser lithotripsy. Unsuccessful extracorporeal shock-wave lithotripsy and electrohydraulic were also performed before laser in 35% and 26% of the cases, respectively. RESULTS: Laser was effective in 79.2% of 72 patients guided by cholangioscopy and in 82.4% of 17 cases steered by fluoroscopy. The median number of impulses in the latter was 4,335 and 1,800 with the former technique. Two parameters influenced the manner of laser guidance. In cases of stones situated above a stricture, cholangioscopic control was more effective (64.7% vs. 31.9%). When the stones were in the distal bile duct, fluoroscopic control was more successful. CONCLUSION: In cases of difficult stones in the distal bile duct, laser lithotripsy under fluoroscopic control is very effective and easily performed. Cholangioscopic guidance should be recommended just in cases of intrahepatic stones or in patients with stones situated proximal to a bile duct stenosis. In these cases, cholangioscopy should be performed either endoscopically or percutaneously.

Delayed Endoscopic Papillary Large Balloon Dilation After Sphincterotomy for Removing Large Bile Duct Stones in Patients with Acute Cholangitis

2014 ◽  
Vol 59 (6) ◽  
pp. 1302-1306 ◽  
Author(s):  
Jong Chan Lee ◽  
Jong Ho Moon ◽  
Hyun Jong Choi ◽  
Dong Choon Kim ◽  
Moon Han Choi ◽  
...  
Keyword(s):  
Bile Duct ◽  
Acute Cholangitis ◽  
Balloon Dilation ◽  
Bile Duct Stones ◽  
Large Balloon ◽  
Large Balloon Dilation ◽  
Large Bile Duct

scholarly journals Risk Factors for Success, Complications, and Death after Endoscopic Sphincterotomy for Bile Duct Stones: A 17-Year Experience with 2,137 Cases

2020 ◽  
Vol 38 (6) ◽  
pp. 534-541 ◽  
Author(s):  
Júlio Carlos Pereira Lima ◽  
Ivan David Arciniegas Sanmartin ◽  
Bruna Latrônico Palma ◽  
Carlos Eduardo Oliveira dos Santos
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Sphincterotomy ◽  
Older Patients ◽  
Bile Duct Stones ◽  
Related Complication ◽  
Endoscopic Retrograde ◽  
Stone Removal

<b><i>Background:</i></b> Risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) complications are well-studied. However, risk factors for complications and success after endoscopic sphincterotomy (EST) for duct stones are poorly determined. This study aimed to verify risk factors for mortality, complications, and success after EST. <b><i>Methods:</i></b> A multivariate analysis was carried out in a dataset of ERCPs performed during 17 years. <b><i>Results:</i></b> A total of5,226 ERCPs were performed, of which 2,137 were in patients with bile duct stones (1,458 women and 679 men; mean age = 57 years) who underwent EST with attempted stone removal. There were 171 (8%) complications, with pancreatitis in 87 (4.1%), bleeding in 48 (2.2%), other complications in 36 (1.8%), and mortality of 0.6%. Successful stone(s) removal was obtained in 2,028 cases (94.9%). On multivariate analysis, mortality was associated with age &#x3e;60 years (1 vs. 0.2%), cholangitis (4.3 vs. 0.3%), and EST-related complications (5.8 vs. 0.2%). Complications were associated with unsuccessful stone removal (13.4 vs. 7.5%) and difficult cannulation (13.9 vs. 5.4%). An unsuccessful EST was independently related to difficult cannulation (86.2 vs. 98.7%), precutting (79.4 vs. 96.4%), and complications (86.5 vs. 95.6%). <b><i>Conclusions:</i></b> Risk factors for complications after EST for stones are delayed bile duct cannulation and failed stone retrieval. Mortality is higher in older patients, those who presented with an EST-related complication, or those who presented initially with cholangitis. Difficult cannulation, EST-related complications, and precutting were associated with an unsuccessful procedure. In this series, outpatient EST with attempted stone retrieval was found to be as safe as performing the procedure in hospitalized patients.

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