Clinical value of DPOC for detecting and removing residual common bile duct stones (video)

Yang, Junjie; Liu, Xiong-Chang; Chen, Xiaoqin; Zhang, Qiyong; Liu, Tian-Rang

doi:10.1186/s12876-019-1045-6

Cited by 9 publications

(7 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thirty-day AEs [5 (12.8%) vs 19 (47.5%); P =0.001] and the reintervention rate [1/39 (2.6%) vs 8/40 (20%); P =0.001] were also significantly lower for EUS-GBD 14 . Although these results are promising, some experts have cautioned that current data do not support that EUS-GBD can replace PT-GBD as the standard of care yet, citing limited long-term outcome data and lack of consensus regarding the need for LAMS removal after cholecystitis resolution 28 . Although there are reports of long-term placement of LAMS resulting in significant tissue overgrowth precluding removal, 29 placement of a DPPS through the LAMS, or replacing it with 2 DPPS at 4 to 6 weeks might mitigate this risk 30 .…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Ultrasound-guided Transluminal Gallbladder Drainage in Patients With Acute Cholecystitis

et al. 2022

View full text Add to dashboard Cite

Objective: To evaluate the safety and efficacy of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using a lumen-apposing metal stent (LAMS). Background: For patients with acute cholecystitis who are poor surgical candidates, EUS-GBD using a LAMS is an important treatment alternative to percutaneous gallbladder drainage. Methods: We conducted a regulatory-compliant, prospective multicenter trial at 7 tertiary referral centers in the United States of America and Belgium. Thirty consecutive patients with mild or moderate acute cholecystitis who were not candidates for cholecystectomy were enrolled between September 2019 and August 2021. Eligible patients had a LAMS placed transmurally with 30 to 60-day indwell if removal was clinically indicated, and 30-day follow-up post-LAMS removal. Endpoints included days until acute cholecystitis resolution, reintervention rate, acute cholecystitis recurrence rate, and procedure-related adverse events (AEs). Results: Technical success was 93.3% (28/30) for LAMS placement and 100% for LAMS removal in 19 patients for whom removal was attempted. Five (16.7%) patients required reintervention. Mean time to acute cholecystitis resolution was 1.6±1.5 days. Acute cholecystitis symptoms recurred in 10.0% (3/30) after LAMS removal. Five (16.7%) patients died from unrelated causes. Procedure-related AEs were reported to the FDA in 30.0% (9/30) of patients, including one fatal event 21 days after LAMS removal; however, no AEs were causally related to the LAMS. Conclusions: For selected patients with acute cholecystitis who are at elevated surgical risk, EUS-GBD with LAMS is an alternative to percutaneous gallbladder drainage. It has high technical and clinical success, with low recurrence and an acceptable AE rate. Clinicaltrials.gov, Number: NCT03767881.

show abstract

Section: Discussionmentioning

confidence: 99%

Endoscopic Ultrasound-guided Transluminal Gallbladder Drainage in Patients With Acute Cholecystitis

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Despite irrigation with 100 mL saline, PAD and a dilated CBD remained independent risk factors for incomplete bile duct clearance. This may be due to the presence of an air-filled duodenum/diverticulum that compresses the distal CBD, making it difficult to wash away the residual stones/sludge[ 29 , 30 ]. CBD clearance can be improved by increasing the volume of saline irrigation.…”

Section: Discussionmentioning

confidence: 99%

Could saline irrigation clear all residual common bile duct stones after lithotripsy? A self-controlled prospective cohort study

Lin¹,

Wang²,

Yue³

et al. 2021

WJG

View full text Add to dashboard Cite

BACKGROUND A previous study showed that irrigation with 100 mL saline reduced residual common bile duct (CBD) stones, which potentially cause recurrent stones after endoscopic retrograde cholangiopancreatography. AIM To determine whether saline irrigation can improve CBD clearance after lithotripsy. METHODS This prospective self-controlled study enrolled patients receiving mechanical lithotripsy for large (> 1.2 cm) CBD stones. After occlusion cholangiography confirmed CBD stone clearance, peroral cholangioscopy (POC) was performed to determine clearance scores based on the number of residual stones. The amounts of residual stones spotted via POC were graded on a 5-point scale (score 1, worst; score 5, best). Scores were documented after only stone removal (control) and after irrigation with 50 mL and 100 mL saline, respectively. The stone composition was analyzed using infrared spectroscopy. RESULTS Between October 2018 and January 2020, 47 patients had CBD clearance scores of 2.4 ± 1.1 without saline irrigation, 3.5 ± 0.7 with 50 mL irrigation, and 4.6 ± 0.6 with 100 mL irrigation ( P < 0.001). Multivariate analysis showed that CBD diameter > 15 mm [odds ratio (OR) = 0.08, 95% confidence interval (CI): 0.01-0.49; P = 0.007] and periampullary diverticula (PAD) (OR = 6.51, 95%CI: 1.08-39.21; P = 0.041) were independent risk factors for residual stones. Bilirubin pigment stones constituted the main residual stones found in patients with PAD ( P = 0.004). CONCLUSION Irrigation with 100 mL of saline may not clear all residual CBD stones after lithotripsy, especially in patients with PAD and/or a dilated (> 15 mm) CBD. Pigment residual stones are soft and commonly found in patients with PAD. Additional saline irrigation may be required to remove retained stones.

show abstract

“…Devices are developed to guide the advancement of D-POC into bile ducts. An example is how in a study by Yang et al [ 15 ] involving 79 patients, the use of D-POC enabled high rates of scope insertion (72.0%). 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.…”

Section: Choledochoscope Adjuncts and Accessoriesmentioning

confidence: 99%

Choledochoscopy: An update

Lee¹,

Teng²,

Shelat³

2021

WJGE

View full text Add to dashboard Cite

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.

show abstract

Clinical value of DPOC for detecting and removing residual common bile duct stones (video)

Cited by 9 publications

References 31 publications

Endoscopic Ultrasound-guided Transluminal Gallbladder Drainage in Patients With Acute Cholecystitis

Endoscopic Ultrasound-guided Transluminal Gallbladder Drainage in Patients With Acute Cholecystitis

Could saline irrigation clear all residual common bile duct stones after lithotripsy? A self-controlled prospective cohort study

Choledochoscopy: An update

Contact Info

Product

Resources

About