Percutaneous endoscopic management of intrahepatic stones in patients with altered biliary anatomy: A case series

Abstract

Incidence of primary intrahepatic stones (IHS) in India is very less as compared to the Far East. However patients with altered biliary anatomy are prone for IHS formation secondary to anastomotic stricture formation. Indian data on percutaneous endoscopic management of IHS is scare. Five patients with IHS were managed percutaneously. All patients had undergone Roux-en-Y hepaticojejunostomy and were not suitable for direct endoscopic intervention. All patients underwent percutaneous biliary drainage followed by cholangioscopy-guided laser lithotripsy. Crushed stones were pushed across the anastomotic site using basket/balloon and ductal clearance was achieved. Good stone pulverization could be achieved in five patients (100 %). Complete ductal clearance could be achieved in all patients (100 %). Cholangioscopy-guided treatment of IHS can be valuable alternative to surgery in select group of patients especially those having dilated biliary tree with absence of intrahepatic strictures. However long-term follow up studies are required to see for recurrence of stone formation.

Percutaneous SpyGlass cholangioscopy for treatment of intrahepatic bile duct calculi

“…PTC‐SpyGlass with EHL for the treatment of intrahepatic calculi has not been described in Australia. Internationally, similar case reports demonstrate comparable results 1–5 ; however, no large cohort studies have been published. Although it is a relatively new procedure, SpyGlass cholangioscopy has been shown to be a diagnostically accurate technique for assessing indeterminate biliary duct strictures.…”

Performance and safety of percutaneous cholangioscopy: a systematic review and meta-analysis

“…1 shows the PRISMA flowchart and Table 1 summarizes the main characteristics of the included studies. Only 1 study was prospective, comparing 2 different old-generation cholangioscopes [ 25 ], 1 retrospective compared PerC with double balloon enteroscopy [ 18 ], 5 were retrospective cohorts [ 15 , 16 , 20 , 21 , 23 ] and 7 case series [ 17 , 19 , 22 , 24 , 27 - 29 ]. It is noteworthy that the vast majority of patients (607/682, 89.0%) came from Asian countries.…”

“…Thirteen studies were graded to have good quality and 1 fair. The most common shortcoming was the absence of a detailed description of the statistics used, reflecting the fact that many studies were case series [ 16 , 17 , 19 , 21 - 23 , 26 , 28 ]. One study was graded as fair regarding quality [ 17 ], because of the absence of details regarding the included cases.…”

Applications of Cholangiopancreatoscopy in Pancreaticobiliary Diseases

“…In addition, percutaneous cholangioscopy, used in conjunction with DPOC, has been successful in the treatment of intrahepatic and bile duct stones in patients with surgically altered anatomy such as Roux-en-Y hepaticojejunostomy [55][56][57][58].…”