Novel peroral cholangioscopy-directed lithotripsy using an ultraslim upper endoscope for refractory Mirizzi syndrome

Abstract

Rationale: Mirizzi syndrome (MS) is an uncommon condition characterized by common hepatic duct (CHD) compression by an impacted gallbladder or cystic duct stones or adjacent inflammation. To date, a standardized therapeutic strategy for MS has not been established yet, owing to its complex clinical presentation. Thus, researchers still have to develop new optimized approaches to solve this problem. Herein, we describe a patient with refractory MS who underwent a successful treatment by novel hybrid anchoring balloon-guided direct peroral cholangioscopy (POC) using an ultraslim endoscope. Patient concerns: A 56-year-old man with a history of biliary stone was referred to our hospital for complaints of discomfort in the right upper quadrant of the abdomen and obstructive jaundice. Endoscopic retrograde cholangiopancreatography showed an 18-mm impacted stone at the level of the cystic duct, which compressed the CHD. The CHD had local stricture, with its upstream and intrahepatic bile duct dilation. Diagnoses: He was diagnosed with type I MS. Interventions: Initially, the patient received an endoscopic major sphincterotomy. However, conventional stone extraction, including mechanical lithotripsy, was unsuccessful. Then, after signing the informed consent form for further treatment, he was successfully treated with novel hybrid anchoring balloon-guided direct POC. Outcomes: The patient had no operative complications and was discharged with cleared ducts. At the 3-year follow-up, he was asymptomatic. Lessons: Our novel hybrid anchoring balloon-guided direct POC may be an effective alternative treatment approach for difficult gallbladder cases, such as refractory MS.

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

“…All patients were diagnosed with CDS prior to intervention with either intraoperative cholangiogram (1), ERCP (4), magnetic resonance cholangiopancreatography (7), computed tomography of the abdomen (2), or endoscopic ultrasound (1). The presenting symptoms included abdominal pain (15), nausea/vomiting (4), and cholangitis (3). Seven patients had hyperbilirubinemia (defined as a bilirubin > 2 mg/dL) at clinical presentation.…”

“…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].…”