Minimally Invasive Approach Using Digital Single-Operator Peroral Cholangioscopy-Guided Electrohydraulic Lithotripsy and Endoscopic Nasogallbladder Drainage for the Management of High-Grade Mirizzi Syndrome

Chon, Hyung Ku; Park, Chan; Kim, Tae Hyeon

doi:10.5946/ce.2021.015

Cited by 6 publications

(5 citation statements)

References 16 publications

(16 reference statements)

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“…5,6 The diagnostic approach is currently performed with clinical presentation, laboratory studies including liver function tests, imaging studies such as computed tomography, magnetic resonance or even the surgical approach, the latter also considered as the gold standard of treatment. 7 Endoscopic retrograde cholangiography is considered an adequate diagnostic method for those patients who are not considered candidates for the surgical approach. Ultrasound is reported to have a diagnostic accuracy of 29% with a sensitivity ranging from 8.3-27%.…”

Section: Discussionmentioning

confidence: 99%

Mirizzi syndrome-differential diagnosis with cholangiocarcinoma: case report

Adame,

Anguiano,

Cortes

et al. 2023

Int J Res Med Sci

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Mirizzi syndrome is a rare complication of gallstone disease and poses a diagnostic challenge for general surgeons due to its clinical presentation, which resembles other pathological entities such as cholangiocarcinoma. We present a clinical case of a 68-year-old female patient with symptoms of jaundice and right upper quadrant pain. During the patient's diagnostic workup, altered liver function tests were documented, highlighting obstructive pattern hyperbilirubinemia, elevated tumor marker CA 19.9, and suspicion of biliary tract tumor based on imaging studies. However, surgical and pathological confirmation revealed Mirizzi syndrome. This case emphasizes the importance of considering differential diagnoses in patients presenting with obstructive jaundice to provide timely and appropriate treatment.

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Section: Discussionmentioning

confidence: 99%

Mirizzi syndrome-differential diagnosis with cholangiocarcinoma: case report

Adame,

Anguiano,

Cortes

et al. 2023

Int J Res Med Sci

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“…Surgery is often complex, with significant rate of AE, and endoscopic clearance is challenging due to the frequent inability to pass or capture the impacted stone [79][80][81]. For such reasons, direct visualization and intraductal lithotripsy is considered as a high effective mini-invasive treatment, with high rate of technical success (Figure 4) [82][83][84][85][86].…”

Section: Cholangioscopy-assisted Lithotripsy: the "New" Lithotripsy Techniquementioning

confidence: 99%

Difficult Biliary Stones: A Comprehensive Review of New and Old Lithotripsy Techniques

et al. 2022

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Biliary stones represent the most common indication for therapeutic endoscopic retrograde cholangiopancreatography. Many cases are successfully managed with biliary sphincterotomy and stone extraction with balloon or basket catheters. However, more complex conditions secondary to the specific features of stones, the biliary tract, or patient’s needs could make the stone extraction with the standard techniques difficult. Traditionally, mechanical lithotripsy with baskets has been reported as a safe and effective technique to achieve stone clearance. More recently, the increasing use of endoscopic papillary large balloon dilation and the diffusion of single-operator cholangioscopy with laser or electrohydraulic lithotripsy have brought new, safe, and effective therapeutic possibilities to the management of such challenging cases. We here summarize the available evidence about the endoscopic management of difficult common bile duct stones and discuss current indications of different lithotripsy techniques.

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“…Since the introduction of cholangioscopy with SpyGlass, a few case reports and case series have demonstrated this method for the management of CDS (▶ Table 6) [5,[14][15][16][17][18][19][20][21][22][23][24]. For example, Issa et al presented the first case of laser lithotripsy using Spyglass cholangioscopy in a patient with postcholecystectomy MS in 2011 [20].…”

Section: (182)mentioning

confidence: 99%

Endoscopic management of cystic duct stones and Mirizzi’s syndrome: experience at an academic medical center

2022

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Background and study aims Cystic duct stones (CDS) are challenging to treat with conventional ERCP techniques due to the small diameter and tortuous nature of the cystic duct. There have been limited studies focused on endoscopic management of CDS. We present our experience managing CDS endoscopically and demonstrate that new advances in endoscopic technology have rendered CDS easier to manage. Patients and methods From 2013 to 2020, we prospectively maintained a database of patients undergoing endoscopic management of CDS. ERCP was performed in all patients, and if unsuccessful in removing stones, cholangioscopy with electrohydraulic lithotripsy (EHL) was utilized. All patients were followed in clinic for outcomes. Results Of 5,123 ERCPs performed at our institution during the study period, 21 patients were diagnosed with CDS. Six patients were successfully treated with conventional ERCP alone. Cholangioscopy with EHL was used in 15 patients undergoing 18 procedures to achieve stone clearance. CDS clearance was achieved in all patients. There was one adverse event (post-ERCP pancreatitis). Spyglass DS was associated with a significant decrease in average procedure time in comparison to first-generation SpyGlass (89.3 vs. 54.4 minutes, P = 0.004). Thirteen patients (87 %) were discharged from the hospital within 24 hours. The median follow-up duration was 23.2 months. Conclusions Endoscopy should be the preferred management strategy for CDS, especially in patients with prior cholecystectomy. Surgical outcomes have been associated with high patient morbidity and hospital length of stay. Our case series is the largest cohort of CDS patients successfully managed with cholangioscopy and EHL in the United States.

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Minimally Invasive Approach Using Digital Single-Operator Peroral Cholangioscopy-Guided Electrohydraulic Lithotripsy and Endoscopic Nasogallbladder Drainage for the Management of High-Grade Mirizzi Syndrome

Cited by 6 publications

References 16 publications

Mirizzi syndrome-differential diagnosis with cholangiocarcinoma: case report

Mirizzi syndrome-differential diagnosis with cholangiocarcinoma: case report

Difficult Biliary Stones: A Comprehensive Review of New and Old Lithotripsy Techniques

Endoscopic management of cystic duct stones and Mirizzi’s syndrome: experience at an academic medical center

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