scholarly journals EUS and ERCP in the Same Session for Biliary Stones: From Risk Stratification to Treatment Strategy in Different Clinical Conditions

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1019
Author(s):  
Pietro Fusaroli ◽  
Andrea Lisotti
Keyword(s):  
Gastrointestinal Endoscopy ◽  
Stone Extraction ◽  
Biliary Stones ◽  
Endoscopic Retrograde ◽  
Cbd Stones ◽  
Clinical Benefits ◽  
The Common ◽  
Clinical Conditions ◽  
Real Time Information ◽  
Time Information

Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and stone extraction is the treatment of choice for choledocholithiasis, reaching a successful clearance of the common bile duct (CBD) in up to 90% of the cases. Endoscopic ultrasound (EUS) has the best diagnostic accuracy for CBD stones, its sensitivity and specificity range being 89–94% and 94–95%, respectively. Traditionally seen as two separate entities, the two worlds of EUS and ERCP have recently come together under the new discipline of bilio-pancreatic endoscopy. Nevertheless, the complexity of both EUS and ERCP led the European Society of Gastrointestinal Endoscopy to identify quality in endoscopy as a top priority in its recent EUS and ERCP curriculum recommendations. The clinical benefits of performing EUS and ERCP in the same session are several, such as benefiting from real-time information from EUS, having one single sedation for both the diagnosis and the treatment of biliary stones, reducing the risk of cholangitis/acute pancreatitis while waiting for ERCP after the EUS diagnosis, and ultimately shortening the hospital stay and costs while preserving patients’ outcomes. Potential candidates for the same session approach include patients at high risk for CBD stones, symptomatic individuals with status post-cholecystectomy, pregnant women, and those unfit for surgery. This narrative review discusses the main technical aspects and evidence from the literature about EUS and ERCP in the management of choledocholithiasis.

scholarly journals Emergency open surgery with a duodenotomy and successful removal of an impacted basket following a complicated endoscopic retrograde cholangiopancreatography procedure: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Ibrahim Abu Shakra ◽  
Maxim Bez ◽  
Amitai Bickel ◽  
Mahran Badran ◽  
Fahed Merei ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Open Surgery ◽  
Rare Complication ◽  
Exploratory Laparotomy ◽  
Biliary Stones ◽  
Endoscopic Retrograde ◽  
Abdominal Ultrasonography ◽  
The Common

Abstract Background Current management of choledocholithiasis entails the use of endoscopic retrograde cholangiopancreatography (ERCP) and clearance of the common bile duct. A rare complication of this procedure is the impaction of the basket by a large stone, which necessitates lithotripsy. Here we report a case of an impacted basket during ERCP, which was managed by open surgery with a duodenotomy and the manual removal of the basket. Case presentation A 79-year-old Caucasian man was admitted to our department with yellowish discoloration of urine, skin and eyes. Abdominal ultrasonography showed a slightly thickened gallbladder, multiple gallbladder stones, dilated intrahepatic bile ducts and extrahepatic bile extending to 1.1 cm. A computed tomography (CT) scan demonstrated a stone in the common bile duct, which caused dilation of the biliary ducts. The patient was diagnosed with obstructive jaundice secondary to choledocholithiasis; and underwent an ERCP, a sphincterotomy and stone extraction. Four days following discharge, the patient was readmitted with jaundice, abdominal pain, vomiting and fever. He was diagnosed with ascending cholangitis and treated initially with antibiotics. A second ERCP revealed a dilated common bile duct and choledocholithiasis. Stone removal with a basket failed, as did mechanical lithotripsy. Finally, the wires of the basket were ruptured and stacked in the common bile duct together with the stone. During exploratory laparotomy, adhesiolysis, a Kocher maneuver of the duodenum and a subtotal cholecystectomy were performed. Choledochotomy did not succeed in removing the impacted wires together with the stone. Therefore, a duodenotomy and an extension of the sphincterotomy were performed, followed by high-pressure lavage of the common bile duct to remove additional small biliary stones. The choledochotomy and duodenotomy were closed by a one-layer suture, and a prophylactic gastroenterostomy was performed to prevent leakage from the common bile duct and the duodenum. The postoperative course was satisfactory. Conclusions This is the first report in the literature of removal of an impacted Dormia basket through the papilla by performing a duodenotomy and an extension of the sphincterotomy, followed by gastroenterostomy.

scholarly journals Migration of Surgical Clips into the Common Bile Duct after Laparoscopic Cholecystectomy

2017 ◽  
Vol 10 (3) ◽  
pp. 787-792 ◽  
Author(s):  
Krishn Kant Rawal
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Acute Cholangitis ◽  
Endoscopic Retrograde ◽  
Surgical Clips ◽  
Cbd Stones ◽  
The Common ◽  
Retained Stones

Laparoscopic cholecystectomy (LC) is currently the treatment of choice for symptomatic gallstones. Associated complications include bile duct injury, retained common bile duct (CBD) stones, and migration of surgical clips. Clip migration into the CBD can present with recurrent cholangitis over a period of time. Retained CBD stones can be another cause of recurrent cholangitis. A case of two surgical clips migrating into the common bile duct with few retained stones following LC is reported here. The patient had repeated episodes of fever, pain at epigastrium, jaundice, and pruritus 3 months after LC. Liver function tests revealed features of obstructive jaundice. Ultrasonography of the abdomen showed dilated CBD with few stones. In view of acute cholangitis, an urgent endoscopic retrograde cholangiopancreatography was done, which demonstrated few filling defects and 2 linear metallic densities in the CBD. A few retained stones along with 2 surgical clips were removed successfully from the CBD by endoscopic retrograde cholangiopancreatography after papillotomy using a Dormia basket. The patient improved dramatically following the procedure.

scholarly journals Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography for the Treatment of Common Bile Duct Stones in Patients with Roux-en-Y Gastrectomy: Outcomes and Factors Affecting Complete Stone Extraction

2021 ◽  
Vol 10 (15) ◽  
pp. 3314
Author(s):  
Taisuke Obata ◽  
Koichiro Tsutsumi ◽  
Hironari Kato ◽  
Toru Ueki ◽  
Kazuya Miyamoto ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Papilla Of Vater ◽  
Stone Extraction ◽  
Endoscopic Retrograde ◽  
Double Balloon Enteroscopy ◽  
Factors Affecting ◽  
Balloon Enteroscopy ◽  
Cbd Stones

Background: Endoscopic retrograde cholangiopancreatography (ERCP) for extraction of common bile duct (CBD) stones in patients with Roux-en-Y gastrectomy (RYG) remains technically challenging. Methods: Seventy-nine RYG patients (median 79 years old) underwent short-type double-balloon enteroscopy-assisted ERCP (sDBE-ERCP) for CBD stones at three referral hospitals from 2011–2020. We retrospectively investigated the treatment outcomes and potential factors affecting complete stone extraction. Results: The initial success rates of reaching the papilla of Vater, biliary cannulation, and biliary intervention, including complete stone extraction or biliary stent placement, were 92%, 81%, and 78%, respectively. Of 57 patients with attempted stone extraction, complete stone extraction was successful in 74% for the first session and ultimately in 88%. The adverse events rate was 5%. The multivariate analysis indicated that the largest CBD diameter ≥14 mm (odds ratio (OR), 0.04; 95% confidence interval (CI), 0.01–0.58; p = 0.018) and retroflex position (OR, 6.43; 95% CI, 1.12–36.81; p = 0.037) were independent predictive factors affecting complete stone extraction achievement. Conclusions: Therapeutic sDBE-ERCP for CBD stones in a relatively elderly RYG cohort, was effective and safe. A larger CBD diameter negatively affected complete stone extraction, but using the retroflex position may be useful for achieving complete stone clearance.

scholarly journals A204 PATIENT FACTORS AND STONE FEATURES AS PROGNOSTIC PREDICTORS IN BILIARY STONE LITHOTRIPSY BY SINGLE-OPERATOR CHOLANGIOPANCREATOSCOPY

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 231-233
Author(s):  
I Sljivic ◽  
D Chahal ◽  
R Trasolini ◽  
F Donnellan
Keyword(s):  
Case Series ◽  
Relative Effect ◽  
Therapeutic Modality ◽  
Complication Rates ◽  
Biliary Stones ◽  
Biliary Stone ◽  
Cbd Stones ◽  
Tertiary Center ◽  
Single Operator ◽  
The Common

Abstract Background Single-operator cholangiopancreatoscopy (SOC) is a therapeutic modality for pancreaticobiliary stone disease that is refractory to traditional ERCP. SOC is still considered a relatively novel technology with limited access in many centers and significant associated costs. Thus, it is imperative to understand the influence patient-based factors and ancillary actions have on the outcome of SOC. Aims We hope to determine if the differences in clinical outcomes amongst cohorts suffice to indicate a re-evaluation of SOC in unfavourable patient populations. We present a series of patients who underwent SOC for biliary stone lithotripsy at a tertiary center with exploratory analysis of factors related to efficacy and adverse events. Methods This is a retrospective, descriptive case series. Cases were identified via query of the electronic medical record between March 2016 and May 2019. We evaluated patient demographics, past medical history, clinical presentation, disease characteristics, complication rates, and patient outcomes. Descriptive statistics are reported. Results 25 unique patients underwent a total of 44 SOC procedures. Mean age was 68 (range 22–88). 13 patients were male. 29 procedures involved a stone in the Common Bile Duct (CBD), 5 in the Common Hepatic & Intrahepatic Ducts (CIHD), 4 in the Pancreatic Duct (PD) and 6 in the Cystic Duct (CD). Symptomatic improvement was achieved in 100% of patients. After a single session, 22.7% of procedures resulted in complete clearance and 59.1% of cases led to partial fragmentation. CBD stones however had an 86.2% clearance rate, compared to an 88–91% success rate in literature. The total complication rate was 16% across age and sex groups. The most common complication was bacteremia in 4 (9.1%) cases. Undifferentiated complication rates were highest with CD stones, while bacteremia was most likely with PD stones. A strong trend was noticed between past SOC procedures and increasing ongoing stone burden, with repeat SOC required less often in patient’s with fewer past SOC procedures. We further observed poorer fragmentation rates for PD stones and a rising trend for repeat SOCs for proximal CBD stones. Conclusions SOC is useful against difficult biliary stones and can provide therapeutic relief without theoretical risks associated with surgery and ERCP. While our study was underpowered to provide generalizable statistics, it is one of the few studies that showed the influence certain comorbidities, stone characteristics and age have on the efficacy and safety of SOC. Our data illustrates the relative effect location and stone-size has on fragmentation and complications rates. Poorer outcomes are more frequent in those with systemic comorbidities and previous surgeries, and rates of complications and failed fragmentation are further exacerbated by age. Funding Agencies None

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