Endoscopic Sphincterotomy in Patients with Difficult Cannulation: Use of an Antegrade Guide

Tanaka, Michio; Matsumoto, Shinji; Ikeda, Shuji; K, Miyazaki; Yamauchi, Shoichiro

doi:10.1055/s-2007-1013013

Cited by 12 publications

(3 citation statements)

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“…Bleeding can mostly be prevented by the use of an alternating coagulating and cutting diathermy apparatus (Erbotom ICC200; ERBE Elektromedizin, Tuebingen, Germany) and, if it occurs, can largely be stopped by endoscopic hemostasis. Acute cholangitis can readily be prevented by routine stenting whenever immediate removal of CBD stones is not feasible after ES 10. Duodenal perforation can be avoided by careful, minimal but sufficient, and correctly directed incision.…”

Section: Endoscopic Sphincterotomy (Es)mentioning

confidence: 99%

“…Changes of the catheter, knife, and lithotomy basket over the guidewire can be aided by the use of the “Rapid Exchange” series (Microvasive; Boston Scientific, Watertown, MA, USA). When the patient has a T‐tube or a percutaneous transhepatic biliary drainage (PTBD) tube, the use of an antegrade guidewire through these routes facilitates introduction of the knife 10…”

Section: Endoscopic Sphincterotomy (Es)mentioning

confidence: 99%

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Bile duct clearance, endoscopic or laparoscopic?

Tanaka

2002

Journal of Hepato-Biliary-Pancreatic Surgery

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Endoscopic sphincterotomy (ES) has become the gold standard nonoperative modality for the removal of common bile duct (CBD) stones. Morbidity is 2%-10%, and mortality less than 2%. Immediate complications include bleeding, cholangitis, pancreatitis, and duodenal perforation, but many of these can be prevented by using various tools, including an alternating coagulating and cutting diathermy unit, routine biliary stenting, frequent use of guide-wires to avoid precutting, and mechanical lithotripsy. Long-term results have shown that the stone recurrence rate reaches 15%, probably due to a strong recurrent tendency inherent to bilirubinate stones. Choice of the appropriate lithotomy modality is of paramount importance to reduce invasiveness. ES is the choice for recurrent or residual stones and for choledocholithiasis alone. Acalculous gallbladders left in place carry no risk of acute cholecystitis. In patients with cholecystocholedocholithiasis, CBD stones should be removed via the cystic duct or by choledochotomy during laparoscopic cholecystectomy, not to preserve the sphincter of Oddi but to reduce the interventional burden. Safety and safeguards of papillary balloon dilation must still be investigated in a limited number of institutions. Marked progress in lithotomy/lithotripsy procedures has almost obviated the need for laparotomy. Patients with CBD stones benefit from the less invasive and more efficient modalities of transpapillary, percutaneous, and laparoscopic lithotomy.

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Section: Endoscopic Sphincterotomy (Es)mentioning

confidence: 99%

Section: Endoscopic Sphincterotomy (Es)mentioning

confidence: 99%

Bile duct clearance, endoscopic or laparoscopic?

Tanaka

2002

Journal of Hepato-Biliary-Pancreatic Surgery

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“…Also, spontaneous migration of stones into the duodenum is frequently noted 17. If complete extraction is unsuccessful, subsequent endoscopic sphincterotomy can be used to clear all retained stones within a few days, with the aid of a guidewire inserted via the C‐tube into the duodenal papilla 18. Our strategy is to insert a C‐tube in all choledochotomy patients to guarantee a short hospital stay even if there are retained stones.…”

Section: Drainage Tube As a Route For Clearance Of Retained Stonesmentioning

confidence: 99%

Laparoscopic choledochotomy for bile duct stones

Shimizu

Yokohata

Mizumoto

et al. 2002

Journal of Hepato-Biliary-Pancreatic Surgery

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In the era of laparoscopic surgery, treatment strategies for common bile duct stones remain controversial. Laparoscopic choledochotomy is usually indicated only when transcystic duct exploration is not feasible. However, laparoscopic choledochotomy provides complete access to the ductal system and has a higher clearance rate than the transcystic approach. In addition, primary closure of the choledochotomy with a running suture and absorbable clips facilitates the procedure. Therefore, to avoid postoperative biliary stenosis, all patients with bile duct stones can be indicated for choledochotomy, except for those with nondilated common bile duct. Placement of a C-tube also provides access for the clearance of possible retained stones by endoscopic sphincterotomy as a backup procedure. C-tube placement, in contrast to T-tube insertion, is advantageous in terms of a relatively short hospital stay. In conclusion, laparoscopic choledochotomy with C-tube drainage is recommended as the treatment of choice for patients with common bile duct stones.

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Combined endoscopic and percutaneous stent insertion to overcome a problem of percutaneous stent insertion

1988

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Non-operative stent insertion is a well-accepted means of palliating malignant biliary obstruction. The endoscopic approach is often considered the procedure of choice, with the percutaneous technique reserved for endoscopy failures. We recently encountered a patient in whom both techniques proved unsuccessful initially, and in whom palliation was finally achieved by means of a combined endoscopic and percutaneous transhepatic procedure.

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Endoscopic Sphincterotomy in Patients with Difficult Cannulation: Use of an Antegrade Guide

Cited by 12 publications

References 0 publications

Bile duct clearance, endoscopic or laparoscopic?

Bile duct clearance, endoscopic or laparoscopic?

Laparoscopic choledochotomy for bile duct stones

Combined endoscopic and percutaneous stent insertion to overcome a problem of percutaneous stent insertion

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