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 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.

scholarly journals Needle-knife fistulotomy vs. standard biliary sphincterotomy for choledocholithiasis: common bile duct stone recurrence and complication rate

2019 ◽  
Vol 07 (12) ◽  
pp. E1733-E1741 ◽  
Author(s):  
Livia Archibugi ◽  
Alberto Mariani ◽  
Gabriele Capurso ◽  
Mariaemilia Traini ◽  
Maria Chiara Petrone ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cbd Stones ◽  
Stone Recurrence ◽  
Hazards Model ◽  
Kaplan Meier ◽  
Biliary Sphincterotomy ◽  
Cbd Stone

Abstract Background and study aims With common bile duct (CBD) stones, access to the CBD can be achieved through the papilla orifice followed by standard biliary sphincterotomy (SBS), or through precut fistulotomy (PF) in case of difficult cannulation. The two methods alter papilla anatomy differently, potentially leading to a different rate of stone recurrence. No data have been published on stone recurrence after PF in patients with CBD stones. The aim of this study was to evaluate CBD stone recurrence, reintervention rate after PF versus SBS, and complications. Patients and methods This was a retrospective single-center cohort study including patients undergoing for the first time endoscopic retrograde cholangiopancreatography (ERCP) for CBD stones with PF in case of failed repeated cannulation attempts, matched for sex/age to patients with SBS randomly extracted from our database. T-test and Fisher’s tests were used for continuous and categorical variable comparison. Recurrence probability was calculated with Kaplan–Meier curve. Factors associated with ERCP repetition were evaluated with logistic regression through a Cox’s proportional hazards model. Results Eighty-five patients with PF were included, with 85 matched controls (mean age 68.7 years, 45.9 % males). Overall, patients with PF had the same reintervention rate as those with SBS (14.1 % vs. 12.9 %) with a hazard ratio (HR) of 1.11 (95 % CI 0.49 – 2.50; P = 0.81), but mean time to reintervention was significantly lower (74.9 ± 74.6 vs. 765.6 ± 961.3 days; P < 0.0001), with 100 % of stones recurring within the first year in the PF group vs. 54.5 % in the SBS group (P = 0.01). The only factor associated with ERCP repetition risk was incomplete CBD clearing. Complications, including pancreatitis, did not differ significantly. Conclusions The reintervention rate was significantly higher in the short term after PF. Therefore, closer follow-up in the first 6 to 12 months after ERCP might be appropriate for patients underoing PF.

scholarly journals Laparoscopic Common Bile Duct Exploration as a Rescue Procedure for Failed Endoscopic Retrograde Cholangio-Pancreatography: A Case Report

2021 ◽  
Author(s):  
Umar Riaz ◽  
Abhijit S Joshi
Keyword(s):  
Case Report ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Treatment Options ◽  
Common Bile Duct Exploration ◽  
Endoscopic Retrograde ◽  
Therapeutic Modalities ◽  
Cbd Stones ◽  
Billroth Ii Gastrectomy ◽  
Cbd Stone

Across the world, choledocholithiasis is presently treated by a two staged approach of Endoscopic Retrograde Cholangio- Pancreatography (ERCP) followed by Laparoscopic Cholecystectomy (LC); in a vast majority of the situations. Modern day literature abounds with comparative outcomes studies between ERCP and Laparoscopic Common Bile Duct Exploration (LCBDE), as therapeutic modalities for Common Bile Duct (CBD) stones. There are strong arguments both in favour and against both these treatment options, in literature. As per literature, the advantage of LCBDE is that it is a single stage procedure, but requires advanced laparoscopic expertise and a choledochoscope in the setup. The advantage of ERCP is that it is a highly standardised procedure. In expert hands and well equipped setups, it rarely ever fails to deliver. However, ERCP is also a highly operator dependant procedure. Also, in the best of hands, sometimes, local factors such as abnormal anatomy, stone morphology can lead to failures or suboptimal results. As per literature, ERCP to extract CBD stones can fail for various reasons such as failed cannulation, previous Billroth II gastrectomy, large CBD stones, large number of CBD stones etc. The failure in retrieving CBD stones by ERCP is an absolute indication for performing CBDE. Here, authors present a case report of a 73-year-old male with failed ERCP (inspite of two attempts) due to a large, solitary but tightly impacted terminal CBD stone. It hopes to convey the message that in similar situations, LCBDE, tactically using some endoscopy accessories, is a sound backup therapeautic option, inspite of non availability of a choledochoscope in the setup. The novelty of this case was that instead of the standard use of choledochoscope to directly visually confirm the completeness of stone clearance during the LCBDE, intraoperative fluoroscopy has been used effectively for the same; by obtaining good quality proximal and distal occlusion cholangiograms at the end of the procedure.

scholarly journals Recurrent Cholangitis due to Hem-o-lok Clip Migration after Laparoscopic Common Bile Duct Exploration Treated with Endoscopic Retrograde Cholangiopancreatography

2021 ◽  
Vol 26 (3) ◽  
pp. 195-199
Author(s):  
Ji Woong Jang ◽  
Jae Hyuck Jun ◽  
Dong-kyu Lee ◽  
Hyeyoung Kim ◽  
Young Seok Doh ◽  
...  
Keyword(s):  
Foreign Body ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Epigastric Pain ◽  
Rare Complication ◽  
Common Bile Duct Exploration ◽  
Endoscopic Retrograde ◽  
Cbd Stones ◽  
Cbd Stone

Clip migration into the common bile duct (CBD) is a rare complication of laparoscopic biliary surgery. We report a case of Hem-o-lok clip migration-induced CBD stone in a 66-year-old man who underwent laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) 4 years ago. The patient visited the emergency room for upper abdominal pain. CT scan revealed increased CBD diameter and multiple CBD stones. We performed endoscopic retrograde cholangiopancreatography for CBD stone extraction. Cholangiography revealed multiple suspected filling defects in the CBD; stones and unknown foreign body were removed using Basket. The foreign body found in the duodenum was a Hem-o-lok clip. When epigastric pain develops in a patient who has undergone LC and LCBDE, it is possible that biliary stone occurs due to clip migration.

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 Surgical procedure for unexpected balloon burst complication during endoscopic balloon dilatation in a patient with common bile duct stones

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Koji Morishita ◽  
Hideaki Sasaki
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Balloon Dilatation ◽  
Rare Complication ◽  
Common Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
Case Presentation ◽  
Endoscopic Balloon Dilatation ◽  
Cbd Stones ◽  
Endoscopic Balloon

Abstract Background Endoscopic balloon dilatation (EBD) is the established treatment for common bile duct (CBD) stones. Although pancreatitis and bleeding have been reported as major complications of EBD, balloon-related complications are rarely reported in EBD. Case presentation A 30-year-old woman with suspected CBD stones underwent endoscopic retrograde cholangiopancreatography (ERCP) and EBD. During EBD, the balloon of the EBD catheter suddenly burst at the biliary sphincter. We therefore performed surgical intervention: removal of the broken EBD catheter and T-tube drainage. Finally, the patient was discharged without any complications. Conclusions We present a case involving a burst balloon of an EBD catheter as a rare complication during EBD, as well as the surgical technique that was used to treat this complication.

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.

Total Bilirubin is a Useful Predictor of Persisting Common Bile Duct Stone in Gallstone Pancreatitis

2008 ◽  
Vol 74 (10) ◽  
pp. 977-980 ◽  
Author(s):  
Tony Chan ◽  
Arezou Yaghoubian ◽  
David Rosing ◽  
Edward Lee ◽  
Roger J. Lewis ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Total Bilirubin ◽  
Bile Duct Stone ◽  
Total Bilirubin Level ◽  
Serum Total Bilirubin ◽  
Gallstone Pancreatitis ◽  
Endoscopic Retrograde ◽  
Cbd Stones ◽  
Unnecessary Procedures

Accepted guidelines for preoperative endoscopic retrograde cholangiopancreatography (ERCP) in gallstone pancreatitis are lacking. Our previous investigations suggested that serum total bilirubin on hospital Day 2 best predicts persisting common bile duct (CBD) stones. We aim to identify an optimal total bilirubin threshold on hospital Day 2 that would predict persisting CBD stones and guide obtaining preoperative ERCP. Prospective and retrospective data were available from 200 consecutive patients with gallstone pancreatitis at a public teaching hospital from 2003 through 2007. Charts were examined for persisting CBD stones on ERCP and/or intraoperative cholangiography during laparoscopic cholecystectomy. Patients with cholangitis (n = 18) were excluded. Nineteen of the remaining 182 (10%) patients had CBD stones. Mean hospital Day 2 bilirubin was 3.7 mg/dL for patients with CBD stones versus 1.4 mg/dL for those without (P < 0.0001). Seventeen patients (9%) had total bilirubin 4 or greater on hospital Day 2. Of these, eight (4%) had CBD stones (specificity 94%). Of the 165 patients with total bilirubin less than 4, 11 (7%) had CBD stones (P < 0.0001). In gallstone pancreatitis, a serum total bilirubin level 4 mg/dL or greater on hospital Day 2 predicts persisting CBD stones with enough specificity to serve as a practical guideline for ERCP while minimizing unnecessary procedures.

Mo1506 Large Size Balloon Dilation of the Ampulla After Biliary Sphincterotomy Facilitate Endoscopic Extraction of Large Common Bile Duct Stones

2011 ◽  
Vol 73 (4) ◽  
pp. AB367
Author(s):  
Gustavo Luz ◽  
Eduardo G.H. De Moura ◽  
Fauze Maluf-Filho ◽  
Tomazo Franzini ◽  
Edson Ide ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Balloon Dilation ◽  
Common Bile Duct Stones ◽  
Bile Duct Stones ◽  
Large Size ◽  
Biliary Sphincterotomy ◽  
Endoscopic Extraction
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