A new hybrid anchoring balloon for direct peroral cholangioscopy using an ultraslim upper endoscope

Background and Aims: Single-operator cholangioscopy-assisted electrohydraulic lithotripsy (SOC-EHL) is effective and safe in difficult choledocholithiasis. The optimal timing of SOC-EHL use, however, in refractory stones has not been elucidated. The following aims to determine the most cost-effective timing of SOC-EHL introduction in the management of choledocholithiasis. Methods: A cost-effectiveness model was developed assessing three strategies with a progressively delayed introduction of SOC-EHL. Probability estimates of patient pathways were obtained from a systematic review. The unit of effectiveness is complete ductal clearance without need for surgery. Cost is expressed in 2018 US dollars and stem from outpatient US databases. Results: The three strategies achieved comparable ductal clearance rates ranging from 97.3% to 99.7%. The least expensive strategy is to perform SOC-EHL during the first endoscopic retrograde cholangiography pancreatography (ERCP) (SOC-1: 18,506$). The strategy of postponing the use of SOC-EHL to the third ERCP (SOC-3) is more expensive (US$18,895) but is 2% more effective. (0.9967). SOC-EHL during the second ERCP in the model (SOC-2) is the least cost-effective. Sensitivity analyses show altered conclusions according to the cost of SOC-EHL, effectiveness of conventional ERCP, and altered willingness-to-pay (WTP) thresholds with early SOC-1 being the most optimal approach below a WTP cut-off of US$20,295. Conclusions: Early utilization of SOC-EHL (SOC-1) in difficult choledocholithiasis may be the least costly strategy with an effectiveness approximating those achieved with a delayed approach where one or more conventional ERCP(s) are reattempted prior to SOC-EHL introduction.

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“…A total of 24 articles were used in the analysis with data abstracted from their full text. 10 , 23 – 45 …”

Section: Resultsmentioning

confidence: 99%

Early cholangioscopy-assisted electrohydraulic lithotripsy in difficult biliary stones is cost-effective

Alrajhi

Barkun

Adam

et al. 2021

Therap Adv Gastroenterol

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“…In general, our specialized hybrid anchoring balloon accessory, which was derived from the intraductal balloon-guided method, has greatly enhanced the performance of direct POC. [ 4 , 11 ] In this case, the balloon of the device used was solidly anchored within the gallbladder so that the lumen was large enough for the balloon to inflate to 20 mm in diameter without causing injury to the gallbladder wall. Additionally, our hybrid anchoring balloon device performed well in maintaining good stability and maneuverability of the ultraslim endoscope during the whole procedure.…”

Section: Discussionmentioning

confidence: 99%

“…The direct POC technique was performed as previously described. [ 4 ] In brief, after performing balloon dilatation of the papilla (to 12 mm in diameter), a 0.035-inch guidewire (Loop tip; Cook Medical Co, Winston-Salem, NC) was placed within the gallbladder to maintain access. The hybrid anchoring balloon-guided device, with a 0.021-inch guidewire tied to the balloon catheter at 2 to 3 mm from its distal end, was inserted into the working channel of the duodenoscope and inflated to anchor it within the gallbladder (Fig.…”

Section: Case Reportmentioning

confidence: 99%

“…[ 3 ] We previously observed that the use of a novel hybrid anchoring balloon device with an ultraslim endoscope performed well in facilitating direct POC for extracting large impacted common bile duct (CBD) stones. [ 4 ] Here, we describe a patient with refractory MS who underwent successful treatment by novel hybrid anchoring balloon-guided direct POC using an ultraslim endoscope.…”

Section: Introductionmentioning

confidence: 99%

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Novel peroral cholangioscopy-directed lithotripsy using an ultraslim upper endoscope for refractory Mirizzi syndrome

Guo

Wang

et al. 2020

Medicine

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Rationale: Mirizzi syndrome (MS) is an uncommon condition characterized by common hepatic duct (CHD) compression by an impacted gallbladder or cystic duct stones or adjacent inflammation. To date, a standardized therapeutic strategy for MS has not been established yet, owing to its complex clinical presentation. Thus, researchers still have to develop new optimized approaches to solve this problem. Herein, we describe a patient with refractory MS who underwent a successful treatment by novel hybrid anchoring balloon-guided direct peroral cholangioscopy (POC) using an ultraslim endoscope. Patient concerns: A 56-year-old man with a history of biliary stone was referred to our hospital for complaints of discomfort in the right upper quadrant of the abdomen and obstructive jaundice. Endoscopic retrograde cholangiopancreatography showed an 18-mm impacted stone at the level of the cystic duct, which compressed the CHD. The CHD had local stricture, with its upstream and intrahepatic bile duct dilation. Diagnoses: He was diagnosed with type I MS. Interventions: Initially, the patient received an endoscopic major sphincterotomy. However, conventional stone extraction, including mechanical lithotripsy, was unsuccessful. Then, after signing the informed consent form for further treatment, he was successfully treated with novel hybrid anchoring balloon-guided direct POC. Outcomes: The patient had no operative complications and was discharged with cleared ducts. At the 3-year follow-up, he was asymptomatic. Lessons: Our novel hybrid anchoring balloon-guided direct POC may be an effective alternative treatment approach for difficult gallbladder cases, such as refractory MS.

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“…Another device to increase chol-edochoscope stability is a hybrid balloon catheter anchoring device using a 0.021-inch guidewire attached to a balloon catheter's distal end. In a single-center retrospective study by Li et al [ 16 ] involving 55 patients, this device-guided D-POC achieved significantly higher technical success rates compared to the conventional wire-guided method (92.7% vs 47.1%, P < 0.05). Another anchoring technique is advancing D-POC over a reusable guide probe of the Kautz device (MTW, Wesel, Germany), designed initially for non-transendoscopic placement of biliary stents.…”

Section: Choledochoscope Adjuncts and Accessoriesmentioning

confidence: 96%

Choledochoscopy: An update

Lee¹,

Teng²,

Shelat³

2021

WJGE

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Choledochoscopy, or cholangioscopy, is an endoscopic procedure for direct visualization within the biliary tract for diagnostic or therapeutic purposes. Since its conception in 1879, many variations and improvements are made to ensure relevance in diagnosing and managing a range of intrahepatic and extrahepatic biliary pathologies. This ranges from improved visual impression and optical guided biopsies of indeterminate biliary strictures and clinically indistinguishable pathologies to therapeutic uses in stone fragmentation and other ablative therapies. Furthermore, with the evolving understanding of biliary disorders, there are significant innovative ideas and techniques to fill this void, such as nuanced instances of biliary stenting and retrieving migrated ductal stents. With this in mind, we present a review of the current advancements in choledo-choscopy with new supporting evidence that further delineates the role of choledochoscopy in various diagnostic and therapeutic interventions, complications, limitations and put forth areas for further study.

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A new hybrid anchoring balloon for direct peroral cholangioscopy using an ultraslim upper endoscope

Abstract: The new hybrid anchoring balloon device performs well in facilitating direct POC using an ultraslim endoscope for evaluation and extraction of residual or large impacted CBD stones.

Cited by 11 publications

References 29 publications

Early cholangioscopy-assisted electrohydraulic lithotripsy in difficult biliary stones is cost-effective

Early cholangioscopy-assisted electrohydraulic lithotripsy in difficult biliary stones is cost-effective

Novel peroral cholangioscopy-directed lithotripsy using an ultraslim upper endoscope for refractory Mirizzi syndrome

Choledochoscopy: An update

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