S2000 EUS-Hepatogastrostomy-Guided Single Operator Cholangioscopy With Laser Lithotripsy and Antegrade Biliary Drainage for Management of Difficult Biliary Stones in Surgically Altered Anatomy

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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Percutaneous Transhepatic Laser Lithotripsy for Biliary Stones in Patients with Altered Biliary Anatomy

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0041-1728985 ◽

2021 ◽

Author(s):

Jacob Indu ◽

Vikrama Amitha Kheda ◽

Deepak Bolbandi ◽

Sanjay Govil ◽

Ravisankar Bhat

Keyword(s):

Bile Duct ◽

Current Treatment ◽

Laser Lithotripsy ◽

Safe Procedure ◽

Bile Duct Stones ◽

Biliary Stones ◽

Endoscopic Retrograde ◽

Difficult Cases ◽

Transhepatic Biliary Drainage ◽

Variant Anatomy

AbstractEndoscopic retrograde cholangiopancreatography (ERCP) is the current treatment of choice in bile duct stones. Several factors such as variant anatomy of ampulla and surgical procedures like hepaticojejunostomy limit the success of ERCP in treating bile duct stones. Percutaneous transhepatic laser lithotripsy using interventional radiologic and endourologic techniques, which is uncommon, is a reasonable treatment option in such difficult cases. It is a minimally invasive, safe procedure accompanied by a high success rate, minimal morbidity, and a short hospital stay. We report our technique and experience in a series of three patients who underwent percutaneous transhepatic biliary drainage (PTBD) followed by percutaneous transhepatic laser lithotripsy in an attempt to avoid open surgery when ERCP was technically difficult.

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Sp696 Switching it up. EUS-Guided Antegrade Clearance of Biliary Stones in “Duodenal Switch” Surgically Altered Anatomy

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2011.03.1214 ◽

2011 ◽

Vol 73 (4) ◽

pp. AB102

Author(s):

Stavros N. Stavropoulos ◽

Teodor C. Pitea ◽

Jessica L. Widmer ◽

Michael D. Harris ◽

Michael E. Khalife ◽

...

Keyword(s):

Duodenal Switch ◽

Biliary Stones ◽

Surgically Altered Anatomy

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Digital single‑operator cholangioscopy in treating difficult biliary stones: results from a multicenter experience

Minerva Gastroenterology ◽

10.23736/s2724-5985.21.02892-8 ◽

2021 ◽

Author(s):

Socrate PALLIO ◽

Emanuele SINAGRA ◽

Alessio SANTAGATI ◽

Fabio D'AMORE ◽

Francesca ROSSI ◽

...

Keyword(s):

Biliary Stones ◽

Single Operator

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Difficult Biliary Stones: A Comprehensive Review of New and Old Lithotripsy Techniques

Medicina ◽

10.3390/medicina58010120 ◽

2022 ◽

Vol 58 (1) ◽

pp. 120

Author(s):

Edoardo Troncone ◽

Michelangela Mossa ◽

Pasquale De Vico ◽

Giovanni Monteleone ◽

Giovanna Del Vecchio Blanco

Keyword(s):

Balloon Dilation ◽

Common Bile Duct Stones ◽

Endoscopic Management ◽

Stone Extraction ◽

Biliary Stones ◽

Electrohydraulic Lithotripsy ◽

Biliary Sphincterotomy ◽

Single Operator ◽

Large Balloon ◽

Large Balloon Dilation

Biliary stones represent the most common indication for therapeutic endoscopic retrograde cholangiopancreatography. Many cases are successfully managed with biliary sphincterotomy and stone extraction with balloon or basket catheters. However, more complex conditions secondary to the specific features of stones, the biliary tract, or patient’s needs could make the stone extraction with the standard techniques difficult. Traditionally, mechanical lithotripsy with baskets has been reported as a safe and effective technique to achieve stone clearance. More recently, the increasing use of endoscopic papillary large balloon dilation and the diffusion of single-operator cholangioscopy with laser or electrohydraulic lithotripsy have brought new, safe, and effective therapeutic possibilities to the management of such challenging cases. We here summarize the available evidence about the endoscopic management of difficult common bile duct stones and discuss current indications of different lithotripsy techniques.

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Troubleshooting Difficult Bile Duct Access: Advanced ERCP Cannulation Techniques, Percutaneous Biliary Drainage, or EUS-Guided Rendezvous Technique?

Gastroenterology Insights ◽

10.3390/gastroent12040039 ◽

2021 ◽

Vol 12 (4) ◽

pp. 405-422

Author(s):

Ting-Ting Chan ◽

Marcus C. H. Chew ◽

Raymond S. Y. Tang

Keyword(s):

Bile Duct ◽

Endoscopic Ultrasound ◽

Biliary Drainage ◽

Percutaneous Biliary Drainage ◽

Rendezvous Technique ◽

Surgically Altered Anatomy ◽

Appropriate Treatment ◽

Benign Pathology ◽

Cannulation Technique ◽

Needle Knife

Despite experienced hands and availability of various well-designed catheters and wires, selective bile duct cannulation may still fail in 10–20% of cases during endoscopic retrograde cholangiopancreatography (ERCP). In case standard ERCP cannulation technique fails, salvage options include advanced ERCP cannulation techniques such as double-guidewire technique (DGW) with or without pancreatic stenting and precut papillotomy, percutaneous biliary drainage (PBD), and endoscopic ultrasound-guided Rendezvous (EUS-RV) ERCP. If the pancreatic duct is inadvertently entered during cannulation attempts, DGW technique is a reasonable next step, which can be followed by pancreatic stenting to reduce risks of post-ERCP pancreatitis (PEP). Studies suggest that early precut papillotomy is not associated with a higher risk of PEP, while needle-knife fistulotomy is the preferred method. For patients with critical clinical condition who may not be fit for endoscopy, surgically altered anatomy in which endoscopic biliary drainage is not feasible, and non-communicating multisegmental biliary obstruction, PBD has a unique role to provide successful biliary drainage efficiently in this particular population. As endoscopic ultrasound (EUS)-guided biliary drainage techniques advance, EUS-RV ERCP has been increasingly employed to guide bile duct access and cannulation with satisfactory clinical outcomes and is especially valuable for benign pathology at centres where expertise is available. Endoscopists should become familiar with each technique’s advantages and limitations before deciding the most appropriate treatment that is tailored to patient’s anatomy and clinical needs.

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AF.136 DIGITAL SINGLE-OPERATOR CHOLANGIOSCOPY IN TREATING DIFFICULT BILIARY STONES: RESULTS FROM A MULTI-CENTER EXPERIENCE

Digestive and Liver Disease ◽

10.1016/s1590-8658(21)00699-x ◽

2021 ◽

Vol 53 ◽

pp. S199

Author(s):

S. Pallio ◽

A. Santagati ◽

E. Sinagra ◽

F. D’Amore ◽

G. Conoscenti ◽

...

Keyword(s):

Biliary Stones ◽

Single Operator

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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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Choledochal Biliary Stones and Laser Lithotripsy: The Laparoscopic Approach

Videoscopy ◽

10.1089/vor.2014.0206 ◽

2014 ◽

Vol 24 (6) ◽

Author(s):

Frédéric Borie ◽

Alban Zarzavadjian Le Bian

Keyword(s):

Laparoscopic Approach ◽

Laser Lithotripsy ◽

Biliary Stones

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