Intraductal US–directed management of bile duct stones without radiocontrast cholangiography

Park, Seon-Young; Park, Chang-Hwan; Lim, Sung-Uk; Cho, Eunae; Lee, Du-Hyeon; Jun, Chung‐Hwan; Kim, Hyunsoo; Choi, Sung‐Kyu; Rew, Jong Sun

doi:10.1016/j.gie.2015.06.015

Cited by 15 publications

(16 citation statements)

References 11 publications

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“…According to the study from Shah JN [7], their successful rate of non-radiation biliary access was about 85%. However, successful biliary access rate can be achieved at 98%-100% [9,10,16]. In our case series, non-radiation biliary access successful rate was 98.1%, and was comparable to that of uoroscopy guided biliary cannulation.…”

Section: Discussionsupporting

confidence: 61%

“…Application of DCS-guided lithotripsy will facilitate endoscopic retrieval of large and di cult stones [11,16,18,19]. However, DCS-guided lithotripsy was performed in a hybrid endoscopic and uoroscopic procedure [11,17,18], and uoroscopy time was not shortened by using DCS-guided lithotripsy [16]. Barakat MT et al reported their experience of DCS-guided electrohydraulic lithotripsy in few unexpectedly complex cases [10].…”

Section: Discussionmentioning

confidence: 99%

“…Our results showed that DCSassisted ERCP is superior to mechanical lithotripsy in conventional ERCP for retrieval of large and di cult CBD stones by presenting a complete stone clearance and less ERCP sessions. Since endoscopic retrieval for di cult CBD stones clearance is a time-consuming procedure [16], both patients and endoscopy staff can be remitted from radiation induced hazard.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, a basket stone extraction was performed instead of planned laser lithotripsy. The mean time of biliary exploration and whole NR-ERCP were 8.60 ± 1.96 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) and 32.96 ± 16.29 (13-82) minutes, respectively. Setting 10 mm as a cut-off value, 27 and 26 patients were with a dilated and a non-dilated CBD.…”

Section: Comparison Of Technical Details and Outcomes Between Two Modmentioning

confidence: 99%

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Application of digital cholangioscopy assisted non-radiation endoscopic retrieval of common bile duct stones

Feng¹,

Xu²,

Liu³

et al. 2020

Preprint

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Background Few studies have evaluated digital cholangioscopy (DCS) assisted non-radiation endoscopic retrograde cholangiopancreatography (NR-ERCP) for choledocholithiasis. Here, we evaluated the application of DCS assisted NR-ERCP for endoscopic retrieval of common bile duct (CBD) stones.Methods Patients who underwent ERCP for choledocholithiasis and without prior ERCP were included. Data related to technical success and outcomes of DCS-assisted NR-ERCP and conventional ERCP were retrieved and compared. Procedure and technical details of DCS assisted NR-ERCP were collated and reviewed.Results In total, 304 and 53 patients who underwent conventional and DCS-assisted ERCP were recruited. Relatively larger stones (p < 0.001) was present in DCS assisted NR-ERCP. No statistical difference was present in biliary access, lithotripsy, stone removal and total complications. A higher proportion of larger balloon for EPBD (p < 0.001) and more ERCP sessions for stone clearance (p < 0.001) were present in conventional ERCP. In DCS-assisted ERCP, technical success was achieved in 52 (98.1%) patients and DCS-guided laser lithotripsy was applied in 9 (17%) patients. DCS guided laser lithotripsy was superior to mechanical lithotripsy for stone clearance (p < 0.001) in large stones. Mean length of biliary exploration and whole NR-ERCP were 8.60 ± 1.96 (6–19) and 32.96 ± 16.29 (13–82) minutes, respectively. One delayed bile-leakage, one moderate pancreatitis, two mild pancreatitis and five cases of hyperamylasemia occurred. Technical details and complications were not statistically differed between patients with a dilated and a non-dilated CBD.Conclusions DCS-based NR-ERCP is technically feasible and safe for retrieval of CBD stones. It provides an alternative to conventional ERCP for endoscopic treatment of simple choledocholithiasis.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Comparison Of Technical Details and Outcomes Between Two Modmentioning

confidence: 99%

See 2 more Smart Citations

Application of digital cholangioscopy assisted non-radiation endoscopic retrieval of common bile duct stones

Feng¹,

Xu²,

Liu³

et al. 2020

Preprint

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“…IDUS is traditionally performed in combination with radiocontrast cholangiography, but several recent studies replaced radiocontrast cholangiogram with IDUS in the management of biliary disease in the rational to prevent contrast injection-related ascending cholangitis, post-ERCP pancreatitis, and adverse reactions to iodine-containing contrast media and to reduce the time of radiation exposure. [ 20 55 56 ] Some investigators have reported using IDUS rather than fluoroscopy to perform emergent bedside ERCP in critically ill patients. [ 57 ]…”

Section: Intraductal Ultrasonography Directed Endoscopic Biliary Procmentioning

confidence: 99%

The role of intraductal ultrasonography in pancreatobiliary diseases

Sun

2016

Endosc Ultrasound

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Intraductal ultrasonography (IDUS) provides real-time, cross-sectional imaging of pancreatobiliary ducts and surrounding structures during endoscopic retrograde cholangiopancreatography using a high-frequency ultrasound (US) transducer. Hence, IDUS has been considered a sensitive tool in the evaluation of suspicious choledocholithiasis and neoplasms, to help distinguish between benign and malignant bile duct strictures or wall thickness, and to assess tumor extension and invasion depth. With the rapid development and enriched choices of sensitive diagnostic modalities include but are not limited to endoscopic US, peroral cholangioscopy, and confocal laser endomicroscopy, it is needed to systematically assess the role of IDUS in the investigation of pancreatobiliary diseases. Some new developments and innovative use of IDUS techniques will be discussed in this paper with the review of literature.

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Endoscopic clearance of non‐complex biliary stones using fluoroscopy‐free direct solitary cholangioscopy: Initial multicenter experience

et al. 2023

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Background and AimsFluoroscopy‐free endoscopic retrograde cholangiopancreatography for common bile duct stone (CBDS) clearance is usually offered only to pregnant patients. We initiated a multicenter, randomized controlled trial comparing clearance of non‐complex CBDSs using fluoroscopy‐free direct solitary cholangioscopy (DSC) to standard endoscopic retrograde cholangiography (ERC) to evaluate the wider applicability of the DSC‐based approach. Here we report the initial results of stone clearance and safety in roll‐in cases for the randomized controlled trial.MethodsTwelve expert endoscopists at tertiary care centers in four countries prospectively enrolled 47 patients with non‐complex CBDSs for DSC‐assisted CBDS removal in an index procedure including fluoroscopy‐free cannulation. Successful CBDS clearance was first determined by DSC and subsequently validated by final occlusion cholangiogram as the ERC gold standard.ResultsFully fluoroscopy‐free cannulation was successful in 42/47 (89.4%) patients. Brief fluoroscopy with minimal contrast injection was used in 4/47 (8.5%) patients during cannulation. Cannulation failed in 1/47 (2.1%) patients. Fluoroscopy‐free complete stone clearance was reached in 38/46 (82.6%) cases. Residual stones were detected in the validation ERC occlusion cholangiogram in three cases. Overall serious adverse event rate was 2.1% (95% confidence interval 0.1–11.3): postprocedural pancreatitis in one patient.ConclusionsIn patients with non‐complex CBDS, the fluoroscopy‐free technique is easily transferred to endoscopic retrograde cholangiopancreatography experts with acceptable rates of cannulation and stone clearance and few serious adverse events. (ClinicalTrials.gov number, NCT03421340)

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Intraductal US–directed management of bile duct stones without radiocontrast cholangiography

Cited by 15 publications

References 11 publications

Application of digital cholangioscopy assisted non-radiation endoscopic retrieval of common bile duct stones

Application of digital cholangioscopy assisted non-radiation endoscopic retrieval of common bile duct stones

The role of intraductal ultrasonography in pancreatobiliary diseases

Endoscopic clearance of non‐complex biliary stones using fluoroscopy‐free direct solitary cholangioscopy: Initial multicenter experience

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