scholarly journals Biliary stone extraction through T-tube tract using flexible fiberoptic choledochoscope

2019 ◽  
Vol 9 (2) ◽  
Author(s):  
Quan Anh Tuấn Lê
Keyword(s):  
Clearance Rate ◽  
Fiber Optic ◽  
Biliary Strictures ◽  
Stone Extraction ◽  
Biliary Stones ◽  
Biliary Stone ◽  
T Tube ◽  
Electrohydraulic Lithotripsy ◽  
Flexible Fiber ◽  
The Mean

Tóm tắt Đặt vấn đề: Còn sỏi sau mổ sỏi đường mật là một vấn đề thường gặp và là một vấn đề khó khăn đối với các phẫu thuật viên gan mật. Mục tiêu: Đánh giá hiệu quả của lấy sỏi mật qua đường hầm ống Kehr với ống soi mềm, kết hợp tán sỏi điện thủy lực. Phương pháp nghiên cứu: Nghiên cứu can thiệp, tiến cứu, không nhóm chứng. Chúng tôi sử dụng ống soi mềm đường mật 5mm, kết hợp với tán sỏi điện thủy lực. Kết quả: Từ tháng 01 năm 2010 đến tháng 01 năm 2013, chúng tôi thực hiện trên 164 bệnh nhân. Tuổi trung bình là 50. Tất cả các trường hợp (TH) đều có sỏi trong gan. Trong đó có 63 bệnh nhân có sỏi ống mật chủ kèm theo. Số lần lấy sỏi trung bình là 4,5 lần (từ 1 đến 10 lần). Có 139 TH (84,8%) phải tán sỏi điện thủy lực vì sỏi to hay dính chặt vào đường mật. Tỉ lệ hết sỏi sau khi lấy qua đường hầm ống Kehr trên cả 3 phương tiện bao gồm nội soi đường mật, siêu âm và X quang sau mổ là 90,9%. Nguyên nhân không lấy hết sỏi do đường mật nhỏ, gập góc hay có hẹp đường mật. Tỉ lệ hẹp đường mật là 34,8% (57 TH). Không có tai biến và biến chứng nặng. Thời gian nằm viện trung bình là 10 ngày. Kết luận: Lấy sỏi mật qua đường hầm ống Kehr kết hợp với tán sỏi điện thủy lực là cách giải quyết sỏi sót và sỏi đường mật trong gan rất hiệu quả và an toàn với tỉ lệ hết sỏi cao và không có biến chứng nặng. Đây là phương pháp tối ưu cho những bệnh nhân còn sỏi sau mổ có mang ống Kehr. Abstract Introduction: Retained biliary stones remain a common clinical problem in patients after surgery and a challenge for hepatobiliary surgeons. Objectives: The aim of this study is to evaluate the efficacy of biliary stone extraction via T-tube tract using a flexible fiber optic choledochoscope and electrohydraulic lithotripsy. Material and Methods: This is a prospective, interventional case series study. A 5mm flexible fiber optic choledochoscope was used in accompanied with electrohydraulic lithotripsy. Results: From January 2010 to January 2013, there were 164 included in this study. The mean age was 50. All of the patients had intrahepatic stones. Among them, 63 patients had common bile duct stones. Stone extractions on average were 4.5 (from 1 to 10 times). Electrohydraulic lithotripsy was necessary in 139 patients (84.8%) because of large or impacted stones. Complete clearance rate was 90.9% consisting of cholagioscopic, ultrasonographic and cholangioghaphic clearances. The most common factors related to failure of stone extraction are small associated with angulated intrahepatic bile ducts and biliary strictures. Biliary strictures were noticed in 57 patients (34.8%). There were no major accidents and complications. The mean hospital stay was 10 days. Conclusion: Biliary stone extraction via T-tube tract with electrohydraulic lithotripsy is a safe and efficient procedure for retained biliary stones and intra-hepatic stones with a high complete clearance rate and no major complications. This is the method of choice for treatment of retained biliary stones in patients with a T-tube in situ. Keywords: Biliary stone extraction, T tube tract.

Result of cholangioscopic electrohydraulic lithotripsy through a percutaneous T-tube for hepatolithiasis at Military Hospital 103

2021 ◽  
Vol 11 (2) ◽  
Author(s):  
Sơn Hải Đỗ ◽  
Keyword(s):  
Fiber Optic ◽  
Military Hospital ◽  
T Tube ◽  
Electrohydraulic Lithotripsy ◽  
Flexible Fiber ◽  
Key Word ◽  
Long Term Follow Up ◽  
Complications Rate

Abstract Bacground: Hepatolithiasis is common in Vietnam. Percutaneous endoscopic electrohydraulic lithotripsy (EHL) is a method of choice for treatment of hepatolithiasis. This study evaluates 10 years of experience using a flexible fiber-optic choledochoscopic to assist in the fragmentation of hepatolithiasis by EHL. Patients and methods: 854 patients with hepatolithiasis were performed percutaneous EHL through T-tube from January 2010 to January 2020 at Military Hospital 103. Patients’demographic, operative and follow-up data after perfoming EHL were retrospectively and prospectively collected for analysis. Results: After EHL, the fragmentation rate was 100% and the complete clearance of stone was 86.53%. The average number of EHL session/patient was 1.79 ± 1.13. Post- EHL complications rate was 9.1%. During long-term follow-up evaluation, recurrent stones accounted for 10.1%. Conclusions: Cholangioscopic electrohydraulic lithotripsy through a percutaneous T-tube for hepatolithiasis was an effective and safe therapy. Key word: Percutaneous endoscopy, EHL, flexible fiber-optic choledochoscopy, hepatolithiasis. Tóm tắt Đặt vấn đề: Sỏi trong gan là một bệnh lý phổ biến ở Việt Nam, gây nhiều biến chứng phức tạp. Nội soi tán sỏi bằng điện thủy lực (Electrohydraulic lithotripsy- EHL) là một phương pháp xâm nhập tối thiểu được lựa chọn để điều trị sỏi trong gan. Nghiên cứu này đánh giá 10 năm kết quả sử dụng hệ thống nội soi ống mềm để điều trị sỏi trong gan bằng EHL qua đường hầm dẫn lưu Kehr. Đối tượng và phương pháp nghiên cứu: Mô tả cắt ngang, hồi cứu kết hợp tiến cứu, không đối chứng trên 854 người bệnh (NB) sỏi đường mật được nội soi tán sỏi bằng điện thủy lực qua đường hầm dẫn lưu Kehr, từ tháng 01 năm 2010 đến tháng 01 năm 2020 tại bệnh viện Quân Y 103. Kết quả: Sau khi thực hiện EHL, 100% NB đều tán được sỏi trong gan. Khả năng tiếp cận sỏi bằng nội soi ống mềm đạt 73,19%; tỷ lệ sạch sỏi 86,53%; sót sỏi 13,47%. Số lần tán sỏi trung bình trên 1 NB là 1,79 ± 1,13 lần; Tỷ lệ biến chứng sau EHL là 9,13%. Trong quá trình theo dõi lâu dài, tỷ lệ sỏi tái phát là 10,11%. Kết luận: Nội soi tán sỏi qua đường hầm dẫn lưu Kehr bằng điện thủy lực là một phương pháp an toàn và hiệu quả để điều trị sỏi trong gan. Từ khóa: Nội soi tán sỏi,EHL, nội soi ống mềm, sỏi trong gan.

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

Medicina ◽  
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.

scholarly journals Clinical Application of a Single-Operator Direct Visualization System Improves the Diagnostic and Therapeutic Yield of Endoscopic Retrograde Cholangiopancreatography

2013 ◽  
Vol 27 (1) ◽  
pp. 15-19 ◽  
Author(s):  
Turki AlAmeel ◽  
Vincent Bain ◽  
Gurpal Sandha
Keyword(s):  
Clinical Utility ◽  
Biliary Tree ◽  
Biliary Disease ◽  
Biliary Strictures ◽  
Biliary Stones ◽  
Visualization System ◽  
Operator Experience ◽  
Electrohydraulic Lithotripsy ◽  
Single Operator ◽  
Biliary Pathology

BACKGROUND: Single-operator cholangioscopy enables direct diagnostic visualization and therapeutic intervention in the biliary tree. There is increasing evidence of its clinical utility in the assessment of biliary strictures and treatment of difficult stones.OBJECTIVE: To describe the first reported Canadian experience with managing biliary disease using single-operator cholangioscopy.METHODS: The present study was a retrospective analysis of data collected from all sequential patients undergoing single-operator cholangioscopy for assessment of biliary strictures and treatment of biliary stones. The main outcome measures were the ability to make an overall diagnosis of stricture (based on visual appearances and tissue histology), and to fragment and extract biliary stones.RESULTS: Thirty patients (17 women), mean age 66 years (range 41 to 89 years) underwent single-operator cholangioscopy. In biliary strictures (20 patients), overall accuracy for visual and tissue diagnosis was 84% and 81%, respectively. Successful electrohydraulic lithotripsy with stone clearance was achieved in 90% of the 10 patients who failed previous conventional therapy. The mean (± SD) procedure time was 61±21 min (range 20 min to 119 min). One patient developed mild postendoscopic retrograde cholangioscopy pancreatitis.CONCLUSION: The results of this experience reaffirms the clinical utility and safety of single-operator cholangioscopy for the management of biliary pathology. Further improvements can be achieved with increasing operator experience and refinements in optical technology.

scholarly journals Percutaneous Transhepatic Cholangioscopy and Stone Extraction in a Patient with Recurrent Cholangitis Following Liver Trauma

2021 ◽  
Vol 11 ◽  
pp. 11
Author(s):  
Lee K. Rousslang ◽  
Omar Faruque ◽  
Kyler Kozacek ◽  
J. Matthew Meadows
Keyword(s):  
Bile Duct ◽  
Bile Duct Injury ◽  
Stone Formation ◽  
Gallstone Pancreatitis ◽  
Stone Extraction ◽  
Biliary Stones ◽  
Interventional Radiologist ◽  
Biliary Stone ◽  
First Case ◽  
Percutaneous Transhepatic Cholangioscopy

Percutaneous transhepatic cholangioscopy (PTCS) is a safe and effective treatment for obstructive biliary stones, when endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful or unavailable. Once percutaneous access is gained into the biliary tree by an interventional radiologist, the biliary ducts can be directly visualized and any biliary stones can be managed with lithotripsy, mechanical fragmentation, and/or percutaneous extraction. We report a case of a 45-year-old man who sustained a traumatic liver laceration and associated bile duct injury, complicated by bile duct ectasia and intrahepatic biliary stone formation. Despite undergoing a cholecystectomy, multiple ERCPs, and percutaneous transhepatic cholangiogram with drain placement, the underlying problem was not corrected leading to recurrent bouts of gallstone pancreatitis and cholangitis. He was ultimately referred to an interventional radiologist who extracted the impacted intrahepatic biliary stones that were thought to be causing his recurrent infections through cholangioscopy. This is the first case of PTCS with biliary stone extraction in the setting of recurrent biliary obstruction and cholangitis due to traumatic bile duct injury.

scholarly journals Is Early Diagnosis of Foreign Body Aspiration Effective in Reducing Re-bronchoscopy in Children?

2021 ◽  
Author(s):  
Mahya Sadat Mohammadi ◽  
Mohammadreza Modaresi ◽  
rohola shirzadi ◽  
Seyed Hossein Mirlohi ◽  
Sedigheh Yousefzadegan ◽  
...  
Keyword(s):  
Foreign Body ◽  
Early Diagnosis ◽  
Fiber Optic ◽  
Foreign Body Aspiration ◽  
P Value ◽  
Medical Sciences ◽  
Foreign Objects ◽  
Flexible Fiber ◽  
Left Bronchus ◽  
The Mean

Abstract Background:Flexible Fiber-optic Bronchoscopy (FFB) is a diagnostic and therapeutic tool for respiratory diseases and evaluation. One of its major advantages is in the diagnosis and treatment of foreign body aspiration.Objectives:This study reports the indications, outcomes, and possible complications of FFB in patients suspected of foreign body aspiration diagnosis in the Iranian population.Methods:The data for this study was gathered from medical records of the patients in Children’s Medical Centre, which is a tertiary pediatric hospital affiliated with Tehran University of Medical Sciences (TUMS), from August 2015 to February 2021.Results:Of the 358 FFBs that were performed for patients suspected of foreign body aspiration diagnosis, major indications included choking (158, 44.13%), coughing (157, 43.58%), wheezing (34, 9.49%), and stridor (6, 1.67%). Nuts were the most common foreign body that was removed among airways in these patients (116, 65.16%). In 15 (4.18%) cases the foreign object was extracted via re-bronchoscopy. The location of 130 foreign objects was identified which right bronchus (52, 40%), left bronchus (38, 29.23%), trachea (8, 6.15%), and carina (6, 4.61%). In 358 procedures that were performed, a total of 27 cases (7.54%) developed complications include hypoxia and laryngospasm. The mean interval from the first sign of choking and the admission of the child into the hospital was 44.43 days ± 10.88 (range: 1 to 1095 days, 95% CI: 22.87-65.99). There was a significant association between later days of admission and the necessity for re-bronchoscopy according to the logistic regression test (p-value=0.012).Conclusion:Our results show that by early diagnosis and hospitalization and so performing flexible fiber-optic bronchoscopy in an earlier time than foreign body aspiration can increase the number of successful procedures.

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

2017 ◽  
Vol 05 (01) ◽  
pp. E54-E58 ◽  
Author(s):  
John Wong ◽  
Raymond Tang ◽  
Anthony Teoh ◽  
Joseph Sung ◽  
James Lau
Keyword(s):  
Clearance Rate ◽  
Laser Lithotripsy ◽  
Efficacy And Safety ◽  
Biliary Stones ◽  
Distal Common Bile Duct ◽  
Stone Clearance ◽  
Biliary Stone ◽  
Peroral Cholangioscopy ◽  
Single Operator ◽  
Spyglass Ds

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.

scholarly journals Is Hepatectomy Necessary in Dealing with Left Hepatolithiasis with Intrahepatic Duct Stricture?

HPB Surgery ◽  
1997 ◽  
Vol 10 (4) ◽  
pp. 265-268 ◽  
Author(s):  
Dominique Franco
Keyword(s):  
Hepatic Resection ◽  
Biliary Stricture ◽  
Difficult Problem ◽  
Treatment Modalities ◽  
Biliary Strictures ◽  
Safe Alternative ◽  
Complete Clearance ◽  
T Tube ◽  
Electrohydraulic Lithotripsy ◽  
Duct Stricture

Background: Hepatolithiasis with intrahepatic biliary strictures, more common in Southeast Asia than elsewhere, remains a difficult problem to manage. Hepatic resection has recently been advocated as one of the treatment modalities for hepatolithiasis; however, this procedure is not without risk. This study was designed to achieve complete clearance of the stones, eliminate bile stasis, and avoid the potential risks of hepatic resection in the patient with hepatolithiasis and intrahepatic biliary stricture.Methods: In this prospective clinical trial 13 patients with retained left hepatolithiasis and intrahepatic biliary strictures were included. All the patients met the following criteria: (1) initial surgical procedure for hepatolithiasis, (2) normal gross findings of the left liver, and (3) no obvious clinical evidence of an associated intrahepatic cholangiocarcinoma. After the operation they underwent matured T-tube tract ductal dilatation with percutaneous transhepatic cholangioscopy tube stenting. Choledoschoscopic electrohydraulic lithotripsy was used in five patients after dilatation when impacted or large stones were encountered.Results: Complete clearance of the stones was achieved in these 13 patients. One patient had fevers develop after ductal dilatation, and another patient had mild hemobilia after electrohydraulic lithotripsy. Both recovered uneventfully with conservative treatment. These successfully treated patients remain well, with a mean follow-up period of 20 months.Conclusions: Postoperative matured T-tube tract ductal dilatation and stenting, combined with endoscopic electrohydraulic lithotripsy when indicated, is an effective and safe alternative to hepatic resection for selected left hepatolithiasis with intrahepatic biliary stricture.

scholarly journals Feasibility of balloon-based endobiliary radiofrequency ablation under cholangioscopy guidance in a swine model

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tadahisa Inoue ◽  
Hiromu Kutsumi ◽  
Mayu Ibusuki ◽  
Masashi Yoneda
Keyword(s):  
Radiofrequency Ablation ◽  
Adverse Events ◽  
Swine Model ◽  
Biliary Strictures ◽  
Tissue Samples ◽  
Ablation Area ◽  
Mucosal Changes ◽  
The Mean ◽  
Preliminary Study

AbstractAlthough endobiliary radiofrequency ablation (RFA) has demonstrated considerable potential for the treatment of biliary strictures, conventional catheter RFA has several limitations. This study aimed to evaluate the feasibility of a novel cholangioscopy (CS)-guided balloon-based RFA procedure in vivo using a swine model. CS-guided balloon-RFA was performed under endoscopic retrograde cholangiography guidance at target temperatures of 60 ℃ or 70 ℃, which were maintained for 60 s. We evaluated the technical feasibility, adverse events, and histological effects associated with the procedure. Twelve sites were ablated in seven miniature pigs. The CS-guided balloon-RFA procedure was technically successful in all cases without any hindrance. Mucosal changes could be detected during RFA, and the ablation area was identified on CS. Necropsy was performed in four pigs on the same day as the procedure: the tissue samples showed coagulative necrosis, and the entire internal circumference of the bile duct was uniformly ablated. The mean lengths of the ablation area in the samples ablated at 60 °C and 70 °C were 20.64 and 22.18 mm, respectively, while the mean depths were 3.46 and 5.07 mm, respectively. The other three pigs were reared and euthanized and autopsied 35 days after the procedure. The site to be ablated had replaced the granulation tissue and fibrotic changes. No adverse events were observed in any case. CS-guided balloon-RFA appears to be a promising option for treating biliary strictures. This preliminary study could pave the way for the evaluation of this procedure in future human clinical trials.

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