The Role of Choledochoscopy

Berci, George; Barber, Kent W.; Williams, James A.

doi:10.1177/1553350615594444

Cited by 12 publications

(5 citation statements)

References 24 publications

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“…With the new advents in digital imaging technology, design of small sized cameras is now feasible and affordable. This has contributed to improved visualization and extraction of bile duct stones 16 . Seeing bile duct stones and removing them under direct vision has the advantage of having visual evidence of clearance rather than using radiological imaging which relies on a column of contrast to indicate no filling defect.…”

Section: Discussionmentioning

confidence: 99%

Retrospective comparative analysis of choledochoscopic bile duct exploration versus ERCP for bile duct stones

Al-Habbal

Reid

Tiang

et al. 2020

Sci Rep

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Debate still exists for the management of choledocholithiasis. The purpose of this study is to quantify the rate of recurrent choledocholithiasis post choledochoscopic bile duct exploration (CBDE) in comparison to ERCP and sphincterotomy, and to demonstrate the feasibility of this approach in a busy metropolitan hospital. Data of patients undergoing CBDE from 2009–2014 at the Northern Hospital, Victoria, Australia, was collected retrospectively. Primary outcomes were bile duct clearance rate and rate of recurrent stones post-clearance. Secondary outcomes measured were post-operative complications, laparoscopic to open conversion rate and operative time. Data of patients undergoing ERCP at the same institution was collected and compared. In total, there were 4,091 cholecystectomy cases performed from 2009–2014, of which 260 (6.3%) of patients had an intraoperative cholangiography (IOC) indicating a common bile duct (CBD) stone. Two hundred and forty-eight patients (95.3%) had a CBDE. The remaining 12 patients (4.6%) had radiological clearance, which were excluded from the study. The overall clearance rate for patients undergoing CBDE was 84% (209/248). The risk of recurrent stones up to 8 years post clearance was 2% (4/209). In the same institution, and between 1998–2012, a total of 1,148 patients underwent ERCP, of which 571 had endoscopic sphincterotomy (ES). Forty-three patients required a repeat ERCP for recurrent CBD stones with a complication rate of 7.5%. Time to recurrence ranged from 6 months to 10 years with a mean of 4.5 years. The rate of recurrence was lower in the CBDE group compared to the patients who had an ERCP (8.9% vs. 2%). CBDE is a feasible and effective method for clearance of CBD stones at the time of laparoscopic cholecystectomy. This approach, although not widely used, reduces the need for ERCP, which has inherent complications. In the longer term, this series showed a significant reduction in the rate of CBD stone recurrence.

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Section: Discussionmentioning

confidence: 99%

Retrospective comparative analysis of choledochoscopic bile duct exploration versus ERCP for bile duct stones

Al-Habbal

Reid

Tiang

et al. 2020

Sci Rep

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“…Choledochoscopy is a well described tool in common duct exploration but can be limited by equipment access or cystic duct diameter in transcystic exploration. [18][19][20] We think the simplistic stepwise, fluoroscopy-guided technique presently described can facilitate widespread adoption of LCBDE beyond a sparse group of enthusiasts. General surgeons may be more likely to use familiar Seldinger technique under fluoroscopy.…”

Section: Discussionmentioning

confidence: 99%

Reclaiming the management of common duct stones in acute care surgery

Bosley

Ganapathy²,

Sanin³

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND Acute care surgery (ACS) is well positioned to manage choledocholithiasis at the time of laparoscopic cholecystectomy, but barriers to laparoscopic common bile duct exploration (LCBDE) include experience and the perceived need for specialized equipment. The technical complexity of this pathway is generally seen as challenging. As such, LCBDE is historically relegated to the “enthusiast.” However, a simplified, effective LCBDE technique as part of a “surgery first” strategy could drive wider adoption in the specialty most often managing these patients. To determine efficacy and safety, we sought to compare our initial ACS-driven experience with a simple, fluoroscopy-guided, catheter-based LCBDE approach during laparoscopic cholecystectomy (LC) to LC with endoscopic retrograde cholangiopancreatography (ERCP). METHODS We reviewed ACS patients who underwent LCBDE or LC + ERCP (pre−/postoperative) at a tertiary care center in the 4 years since starting this surgery first approach. Demographics, outcomes, and length of stay (LOS) were compared on an intention to treat basis. Laparoscopic common bile duct exploration was performed via using wire/catheter Seldinger techniques under fluoroscopic guidance with flushing or balloon dilation of the sphincter as needed. Our primary outcomes were LOS and successful duct clearance. RESULTS One hundred eighty patients were treated for choledocholithiasis with 71 undergoing LCBDE. The success rate of catheter-based LCBDE was 70.4%. Length of stay was significantly reduced for the LCBDE group compared with the LC + ERCP group (48.8 vs. 84.3 hours, p < 0.01). Of note, there were no intraoperative or postoperative complications in the LCBDE group. CONCLUSION A simplified catheter-based approach to LCBDE is safe and associated with decreased LOS when compared with LC + ERCP. This simplified step-up approach may help facilitate wider LCBDE utilization by ACS providers who are well positioned for a timely surgery first approach in the management of uncomplicated choledocholithiasis. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.

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“…Laparoscopic bile duct exploration techniques have still been refined and consolidated, although the studies that have compared the single-time surgical handle against the sequential handle are few; both modalities show similarities in terms of common bile duct cleaning and complications, however single-time handle results in a shorter hospital stay reduced costs. In that regard, BDS handle depends nowadays on the surgical team's experience and the technological availability of hospital centers (8)(9)(10) .…”

Section: Introductionmentioning

confidence: 99%

Experiencia en el tratamiento quirúrgico de la coledocolitiasis no resuelta por CPRE en el Hospital Nacional de Itauguá de enero a octubre de 2022

Ríos,

Franco-López,

Echagüe

2023

Cir. parag.

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Introducción: La coledocolitiasis es la presencia de cálculos en el colédoco como consecuencia de su migración desde la vesícula o de su formación en la vía biliar extrahepática o intrahepática. Objetivo: Determinar la conducta quirúrgica adoptada para el tratamiento de la coledocolitiasis no resuelta por CPRE. Materiales y métodos: Estudio observacional, retrospectivo, descriptivo, de corte transversal. Resultados: De los pacientes en estudio se hallaron cáculos en el 62% de las CPRE realizadas, en los cuales se pudo resolver el cuadro en 85% (151/245). La edad media fue de 56,3 ± 20,75 años con mayor predominio del sexo femenino en el 78%. En los demás pacientes la técnica quirúrgica evidenció en la mayoría se realizó cirugía abierta (22/23) y coledocotomía, más frecuentemente con rafia primaria (14/23). Un solo caso fue resuelto por laparoscopía. Conclusión: para el tratamiento quirúrgico de las coledocolitiasis se utiliza principalmente la vía abierta, y la coledocotomía con rafia primaria.

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The Role of Choledochoscopy

Abstract: Digital, image enhanced, distal tipped chip flexible endoscopes have significantly improved the surgeons' ability to see within the bile duct, improving the efficiency and ease of stone visualization and removal from both the most proximal and distal ends of the bile duct.

Cited by 12 publications

References 24 publications

Retrospective comparative analysis of choledochoscopic bile duct exploration versus ERCP for bile duct stones

Retrospective comparative analysis of choledochoscopic bile duct exploration versus ERCP for bile duct stones

Reclaiming the management of common duct stones in acute care surgery

Experiencia en el tratamiento quirúrgico de la coledocolitiasis no resuelta por CPRE en el Hospital Nacional de Itauguá de enero a octubre de 2022

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