Endoscopic Management of Difficult Bile Duct Stones

Aburajab, Murad; Dua, Kulwinder S.

doi:10.1007/s11894-018-0613-1

Cited by 31 publications

(34 citation statements)

References 77 publications

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“…Mechanical lithotripsy was once the preferred method to facilitate stone fragmentation and extraction of large CBD stones [14]. However, in many experienced centers, mechanical lithotripsy is now falling behind EPLBD [15]. Digital cholangioscopyguided laser lithotripsy or electrohydraulic lithotripsy have become more popular owing to the convenience in assembly [14,16,17].…”

Section: Introductionmentioning

confidence: 99%

Digital cholangioscopy-guided laser versus mechanical lithotripsy for large bile duct stone removal after failed papillary large-balloon dilation: a randomized study

et al. 2019

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Background Endoscopic papillary large-balloon dilation (EPLBD) allows for the complete removal of large common bile duct (CBD) stones without fragmentation; however, a significant proportion of very large stones and stones floating above a tapering CBD require lithotripsy. Mechanical lithotripsy and cholangioscopy-guided laser lithotripsy are both effective for stone fragmentation. This study aimed to directly compare, for the first time, the efficacy of these two techniques in terms of stone clearance rate, procedure duration, patient radiation exposure, and safety. Methods 32 patients with very large CBD stones or with stones floating above a tapering CBD, and in whom extraction after standard sphincterotomy and/or EPLBD had failed, were randomly assigned to mechanical lithotripsy or cholangioscopy-guided laser lithotripsy at two tertiary referral centers. Crossover was allowed as a rescue treatment if the assigned technique failed. Results Patients’ demographic data were not different between the two groups. Mechanical lithotripsy had a significantly lower stone clearance rate in the first session compared with laser lithotripsy (63% vs. 100%; P < 0.01). Laser lithotripsy rescued 60% of patients with failed mechanical lithotripsy by achieving complete stone clearance within the same session. Radiation exposure of patients was significantly higher in the mechanical lithotripsy group than in the laser lithotripsy group (40 745 vs. 20 989 mGycm2; P = 0.04). Adverse events (13% vs. 6%; P = 0.76) and length of hospital stay (1 vs. 1 day; P = 0.27) were not different. Conclusions Although mechanical lithotripsy is the standard of care for a very large CBD stone after failed EPLBD, where available, cholangioscopy-guided laser lithotripsy is considered the better option for the treatment of this entity as it provides a higher success rate and lower radiation exposure.

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Section: Introductionmentioning

confidence: 99%

Digital cholangioscopy-guided laser versus mechanical lithotripsy for large bile duct stone removal after failed papillary large-balloon dilation: a randomized study

et al. 2019

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“…Lithotripsy can be performed using a mechanical lithotripsy (ML) device or cholangioscopy-directed lithotripsy. 12 ML is performed using a lithotripsy compatible basket to crush large stones in small fragments for extraction. The basket is attached to a lithotripsy handle and crank that is rotated until the stone is crushed by the lithotripsy wire and cable.…”

Section: Therapeutic Ercpmentioning

confidence: 99%

Endoscopic Pancreato-Biliary Interventions

Raza¹,

Krishnan

2018

Dig Dis Interv

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Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) play a critical role in the diagnosis and management of benign and malignant pancreatobiliary diseases. In the last several years, role of ERCP has evolved from just a diagnostic procedure to mostly a therapeutic procedure. It plays a key role in the diagnosis of indeterminate biliary strictures and evaluation of bile leaks. Therapeutic ERCP utilizes various techniques for the extraction of biliary and pancreatic stones, management of bile leaks, and the treatment of malignant and benign strictures. EUS plays a central role in tissue acquisition for diagnostic purposes. Therapeutic applications of EUS have significantly increased in the recent years and include management of pancreatic fluid collections, pancreatic necrosis, drainage of the biliary obstruction, gall bladder drainage, and EUS-assisted ERCP. These procedures have good efficacy and acceptable side effect profile when performed by expert endoscopists at tertiary care medical centers.

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“…Since its introduction in 1974, ERCP has become the standard method for removing bile duct stones, which involves endoscopic sphincterotomy with balloon or basket for removal of stones. The success rate for removal of common bile duct stones ranges from 80 to 90% [ 3 , 4 ]. An unusual but possible complication is Dormia basket impaction or Traction cable breakage when removing CBD stones.…”

Section: Introductionmentioning

confidence: 99%