Outcomes of Single-Operator Cholangioscopy-Guided Lithotripsy in Patients with Difficult Biliary and Pancreatic Stones

Canena, Jorge; Lopes, Luís; Fernandes, J; Alexandrino, Gonçalo; Lourenço, Luís Carvalho; Libânio, Diogo; Horta, David; Giestas, Sílvia; Reis, Jorge

doi:10.1159/000488508

Cited by 23 publications

(28 citation statements)

References 16 publications

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“…The rate of overall adverse events for the SpyDS group in this study was 24%, which is higher than the rates described in previous reports, which ranged from 1.5% to 14% ( 6 - 9 , 18 ). This may be due to the fact that our study population included more difficult-to-manage cases than the previous studies did.…”

Section: Discussioncontrasting

confidence: 81%

Peroral Cholangioscopy-guided Electrohydraulic Lithotripsy with a SpyGlass DS Versus a Conventional Digital Cholangioscope for Difficult Bile Duct Stones

et al. 2020

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Objective Recently, a new digital peroral cholangioscopy (POCS) system, the SpyGlass DS (SpyDS), has been used for POCS-guided lithotripsy for difficult bile duct stones (DBDSs). The aim of this retrospective study was to compare the efficacy of SpyDS-guided electrohydraulic lithotripsy (EHL) for DBDS with that of a conventional digital cholangioscope. Methods Seventeen consecutive patients who had undergone POCS-guided EHL for DBDS with the SpyDS between October 2015 and January 2019 were enrolled in this study group (SpyDS group) using a prospectively maintained database. Fifteen other consecutive patients who had undergone POCS-guided EHL with a conventional digital cholangioscope (CHF-B260) just prior to the introduction of the SpyDS between December 2006 and September 2015 were analyzed as a control group (CHF group). The main outcome measurement was the total procedure time to complete stone removal. Results The rate of complete stone removal was 100% for both groups. The mean total procedure time for the SpyDS group was significantly shorter than that for the CHF group (67±30 minutes vs. 107±64 minutes, p=0.038). The mean number of endoscopic sessions for the SpyDS group was significantly lower than that for the CHF group (1.35±0.49 vs. 2.00±0.85, p=0.037). There were no significant differences in the rate of adverse events between the two groups. Conclusion The SpyDS appears useful for decreasing the procedure time and number of endoscopic sessions for complete stone removal in POCS-guided EHL for DBDS compared with a conventional digital cholangioscope.

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Section: Discussioncontrasting

confidence: 81%

Peroral Cholangioscopy-guided Electrohydraulic Lithotripsy with a SpyGlass DS Versus a Conventional Digital Cholangioscope for Difficult Bile Duct Stones

et al. 2020

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“…There was a total of 16 studies that reported on POP lithotripsy procedures. Ten of these studies reported outcomes on POP using EHL[ 2 , 7 - 9 , 20 , 21 , 23 , 25 , 29 , 30 ] and 8 studies reported outcomes on POP using LL[ 2 , 20 , 21 , 24 , 26 - 28 , 31 ].…”

Section: Resultsmentioning

confidence: 99%

“…Technical success rate was defined as the rate of clearing the pancreatic duct stones[ 2 , 7 - 9 , 20 - 31 ]. Clinical success was defined as improvement of the symptoms, primarily pain[ 2 , 7 , 20 - 26 , 28 - 31 ]. AE was defined as complications directly related to the procedure.…”

Section: Methodsmentioning

confidence: 99%

Efficacy of pancreatoscopy for pancreatic duct stones: A systematic review and meta-analysis

Saghir

Mashiana

Mohan

et al. 2020

WJG

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BACKGROUND Pancreatic duct stones can lead to significant abdominal pain for patients. Per oral pancreatoscopy (POP)-guided intracorporal lithotripsy is being increasingly used for the management of main pancreatic duct calculi (PDC) in chronic pancreatitis. POP uses two techniques: Electrohydraulic lithotripsy (EHL) and laser lithotripsy (LL). Data on the safety and efficacy are limited for this procedure. We performed a systematic review and meta-analysis with a primary aim to calculate the pooled technical and clinical success rates of POP. The secondary aim was to assess pooled rates of technical success, clinical success for the two individual techniques, and adverse event rates. AIM To perform a systematic review and meta-analysis of POP, EHL and LL for management of PDC in chronic pancreatitis. METHODS We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed, EMBASE, Cochrane, Google Scholar and Web of Science databases (from 1999 to October 2019) to identify studies with patient age greater than 17 and any gender that reported on outcomes of POP, EHL and LL. The primary outcome assessed involved the pooled technical success and clinical success rate of POP. The secondary outcome included the pooled technical success and clinical success rate for EHL and LL. We also assessed the pooled rate of adverse events for POP, EHL and LL including a subgroup analysis for the rate of adverse event subtypes for POP: Hemorrhage, post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP), perforation, abdominal pain, fever and infections. Technical success was defined as the rate of clearing pancreatic duct stones and clinical success as the improvement in pain. Random-effects model was used for analysis. Heterogeneity between study-specific estimates was calculated using the Cochran Q statistical test and I 2 statistics. Publication bias was ascertained, qualitatively by visual inspection of funnel plot and quantitatively by the Egger test. RESULTS A total of 16 studies including 383 patients met the inclusion criteria. The technical success rate of POP was 76.4% (95%CI: 65.9-84.5; I 2 = 64%) and clinical success rate was 76.8% (95%CI: 65.2-85.4; I 2 = 66%). The technical success rate of EHL was 70.3% (95%CI: 57.8-80.3; I 2 = 36%) and clinical success rate of EHL was 66.5% (95%CI: 55.2-76.2; I 2 = 19%). The technical success rate of LL was 89.3% (95%CI: 70.5-96.7; I 2 = 70%) and clinical success rate of LL was 88.2% (95%CI: 66.4-96.6; I 2 = 77%). The incidence of pooled adverse events for POP was 14.9% (95%CI: 9.2-23.2; ...

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“…In the study, the cost analysis indicated that the reduced overall POC sessions and complication rates contributed to the medical cost cutting for patients. Actually, various measures of lithotripsy might be considered when EHL fails, and laser lithotripsy was a well-established method commonly used in multiple centers 34,35,36 . However, laser lithotripsy was reported with limitations of higher costs due to an expensive equipment, poor exploding force, and fragility of the probe 36,37 .…”

Section: Discussionmentioning

confidence: 99%

Combined lithotripsy of mechanical clamping and electrohydraulics in facilitating endoscopic management of refractory residual biliary calculi after surgery

Wen¹,

Ren²,

Wang³

et al. 2020

Sci Rep

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Although postoperative cholangioscopy (POC) guided electrohydraulic lithotripsy (EHL) is considered to be a conventional technique for residual biliary calculi, its efficacy still needs to be improved to fit in the managemet of refractory calculi. This study evaluated the efficacy and safety of combined lithotripsy of mechanical clamping and electrohydraulics in fragmentation and removal of refractory calculi. Totally, 281 patients, who suffered from residual biliary calculi after hepatectomy and underwnet POC from August 2016 to June 2018 were involved. The first 128 patients were subjected to conventional EHL, and later consective 153 to combined lithotripsyof mechanical clamping and EHL. Perioperative data, technical information, treatment outcomes and follow-up results were collected. Clinical characteristics were statistically comparable (P > 0.05). The overall POC interventional sessions (2.0 ± 0.65 vs. 2.9 ± 1.21 sessions), average operating time (99.1 ± 34.88 vs. 128.6 ± 72.87 minutes), incidence of intraoperative hemobilia (4.58% vs. 10.93%), cholangitis (6.54% vs. 14.06%), postoperative complications (10.45% vs. 21.87%), T-tube retaining time after first POC (20.7 ± 5.35 vs. 28.1 ± 8.28 days), and treatment costs ($2375 ± 661.72 vs. $3456.7 ± 638.07) were significantly lower in the combined lithotripsy group than those in the EHL group (P < 0.05). There were no differences between the two groups in calculi recurrence at half-a year, or one year follow-up. In conclusion, combined lithotripsy of mechanical clamping and electrohydraulics can safely and effectively benefit postoperative patients along with refractory residual biliary calculi. Although biliary calculus is a benign disease characterized for the presence of intrahepatic bile duct calculi, it may cause serious complications 1,2. Hepatectomy combined with intraoperative cholangioscopy is regarded as the most helpful approach not only for the removal of the intrahepatic calculi and lesions, but also for reducing the risk of calculi recurrence and cholangitis 3. Unfortunately, this technique is not suitable for complicated calculi distributing bilobarly or diffusely 4. In management of complicated calculi, placement of a T-tube drainage for further postoperative cholangioscopy (POC) was feasible, which allows for repeated sessions for calculi extraction 5,6. When dealing with complicated residual biliary calculi such as with large size, hard consistency, or anatomical abnormalities, conventional POC managements including perfusion and basket extraction are often difficult, or even impossible in patients with impacted calculi 7. Among advanced therapeutic strategies including electrohydraulic lithotripsy (EHL), laser lithotripsy, pneumatic lithotripsy and hyperacoustic lithotripsy, the EHL being the most commonly used in clinic because of its efficiency and low costs 8-11. It allows calculi to be crushed by energy absorption, which leads to a build-up of pressure gradients and the formation of shear and tear forces 9 .

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Outcomes of Single-Operator Cholangioscopy-Guided Lithotripsy in Patients with Difficult Biliary and Pancreatic Stones

Cited by 23 publications

References 16 publications

Peroral Cholangioscopy-guided Electrohydraulic Lithotripsy with a SpyGlass DS Versus a Conventional Digital Cholangioscope for Difficult Bile Duct Stones

Peroral Cholangioscopy-guided Electrohydraulic Lithotripsy with a SpyGlass DS Versus a Conventional Digital Cholangioscope for Difficult Bile Duct Stones

Efficacy of pancreatoscopy for pancreatic duct stones: A systematic review and meta-analysis

Combined lithotripsy of mechanical clamping and electrohydraulics in facilitating endoscopic management of refractory residual biliary calculi after surgery

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