RESUMO
BACKGROUND: Infection outbreaks associated with contaminated reusable duodenoscopes (RUDs) have induced the development of novel single-use duodenoscopes (SUDs). This study aimed to analyze the material composition and life cycle assessment (LCA) of RUDs and SUDs to assess the sustainability of global and partial SUD implementation. METHODS: A single-center study evaluated material composition analysis and LCA of one RUD and two SUDs from different manufacturers (A/B). Material composition analysis was performed to evaluate the thermochemical properties of the duodenoscope components. The carbon footprint was calculated using environmental software. We compared the sustainability strategies of universal use of RUDs, frequent use of RUDs with occasional SUDs, and universal use of SUDs over the lifetime of one RUD. RESULTS: RUDs were substantially heavier (3489 g) than both SUD-A (943 g) and SUD-B (716 g). RUDs were mainly metal alloys (95%), whereas SUDs were mainly plastic polymers and resins (70%-81%). The LCA demonstrated the sustainability of RUDs, with a life cycle carbon footprint 62-82 times lower than universal use of SUDs (152 vs. 10 512-12 640 kg CO2eq) and 10 times lower than occasional use of SUDs (152 vs. 1417-1677 kg CO2eq). Differences were observed between SUD-A and SUD-B (7.9 vs. 6.6 kg CO2eq per endoscope). End-of-life incineration emissions for SUDs were the greatest environmental contributors. CONCLUSIONS: Widespread adoption of SUDs has greater environmental challenges; it requires a balance between infection control and environmental responsibility. Carbon footprint labelling can help healthcare institutions make sustainable choices and promote environmentally responsible healthcare practices.
RESUMO
OBJECTIVES: GI endoscopy units represent the third largest producers of medical waste. We aimed to determine endoscopic instrument composition and life cycle assessment (LCA) and to assess a sustainability proposal based on a mark on the instruments that identifies parts can be safely recycled or 'green mark'. DESIGN: Material composition analysis and LCA of forceps, snares and clips from four different manufacturers (A-D) were performed with four different methods. Carbon footprint from production, transportation and end of life of these instruments was calculated. In 30 consecutive procedures, we marked the contact point with the working channel. 5 cm away from that point was considered as green mark. One-week prospective study was conducted with 184 procedures evaluating 143 instruments (75 forceps, 49 snares and 19 haemoclips) to assess the efficacy of this recyclable mark. RESULTS: Composition from different manufacturers varied widely. Most common materials were high global warming potential (GWP) waste (polyethylene, polypropylene and acrylonitrile) and low GWP waste (stainless steel). Significant differences were found for the forceps (0.31-0.47 kg of CO2 equivalent (CO2-eq)) and haemoclips (0.41-0.57 kg CO2-eq) between the manufacturers. Green mark was established 131.26 cm for gastroscope and 195.32 cm for colonoscope. One-week activity produced 67.74 kg CO2-eq. Applying our sustainability intervention, we could reduce up to 27.44% (18.26 kg CO2-eq). This allows the recycling of 61.7% of the instrument total weight (4.69 kg). CONCLUSION: Knowledge of carbon footprint is crucial to select the most sustainable alternatives because there are large variations between brands. A mark to identify recyclable parts could reduce our environmental impact significantly.
Assuntos
Dióxido de Carbono , Meio Ambiente , Humanos , Animais , Estudos Prospectivos , Endoscopia , Estágios do Ciclo de VidaRESUMO
Endoscopic retrograde cholangiopancreatography (ERCP) is the technique of choice for the treatment of biliopancreatic pathology. However, fluoroscopic imaging does not always allow an adequate diagnosis. On the other hand, some large stones cannot be removed by the usual methods. In these situations, cholangioscopy has proven to be an essential tool for the diagnosis of biliary strictures and the treatment of large stones. Its role in pancreatic pathology is also increasing. The development of a single-operator, disposable cholangioscope has made it possible to expand the technique to a large number of hospitals that perform ERCP. For this reason, the Spanish Society of Digestive Endoscopy has developed this consensus document on the use of the Spyglass-DS cholangioscope. The document has been prepared by a group of endoscopists with expertise in cholangioscopy, reviewing the scientific evidence on the main current indications for cholangiopancreatoscopy.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colestase , Humanos , Consenso , Colangiopancreatografia Retrógrada Endoscópica/métodos , Endoscopia Gastrointestinal , PâncreasRESUMO
Current enteroscopy techniques present complications that are intended to be improved with the development of a new semi-automatic device called Endoworm. It consists of two different types of inflatable cavities. For its correct operation, it is essential to detect in real time if the inflatable cavities are malfunctioning (presence of air leakage). Two classification predictive models were obtained, one for each cavity typology, which must discern between the "Right" or "Leak" states. The cavity pressure signals were digitally processed, from which a set of features were extracted and selected. The predictive models were obtained from the features, and a prior classification of the signals between the two possible states was used as input to different supervised machine learning algorithms. The accuracy obtained from the classification predictive model for cavities of the balloon-type was 99.62%, while that of the bellows-type was 100%, representing an encouraging result. Once the models are validated with data generated in animal model tests and subsequently in exploratory clinical tests, their incorporation in the software device will ensure patient safety during small bowel exploration.
Assuntos
Algoritmos , Software , AnimaisRESUMO
BACKGROUND & AIMS: Colorectal (CRC) screening programs represent a large volume of procedures that need a follow-up endoscopy. A knowledge-based clinical decision support system (K-CDSS) is a technology which contains clinical rules and associations of compiled data that assist with clinical decision-making tasks. We develop a K-CDSS for management of patients included in CRC screening and surveillance of colorectal polyps. METHODS: We collected information on 48 variables from hospital colonoscopy records. Using DILEMMA Solutions Platform © (https://www.dilemasolution.com) we designed a prototype K-CDSS (PoliCare CDSS), to provide tailored recommendations by combining patients data and current guidelines recommendations. The accuracy of rules was verified using four scenarios (normal colonoscopy, lesions different than polyps, non-advanced adenomas and advanced adenomas). We studied the degree of agreement between the clinical assessments made by expert doctors and nurses equipped with PoliCare CDSS. Two experts confirmed a correlation between guidelines and PoliCare recommendations. RESULTS: 56 consecutive endoscopy cases from colorectal screening program were included (62.8 years; range 53-71). Colonoscopy results were: absence of colon lesions (n=7, 12.5%), lesions in the colon that are not polyps (n=3, 5.4%) and resected colonic polyps (n=46, 82.1%; 100% R0 resection). Patients with resected polyps presented non-advanced adenoma (n=21, 45.6%) or advanced lesions (n=25, 54.4%). There were no differences in erroneous orders with PoliCare CDSS (Kappa value 1.0). CONCLUSIONS: PoliCare CDSS can easily be integrated into the workflow for improving the overall efficiency and better adherence to evidence-based guidelines.
Assuntos
Adenoma , Pólipos do Colo , Neoplasias Colorretais , Sistemas de Apoio a Decisões Clínicas , Pólipos do Colo/diagnóstico , Pólipos do Colo/patologia , Pólipos do Colo/cirurgia , Colonoscopia/métodos , Neoplasias Colorretais/patologia , Humanos , Estudos RetrospectivosRESUMO
Direct endoscopic visualization of biliary and pancreatic ducts represents one step further in the journey of digestive endoscopy. It allows the identification of lesions that were previously attainable through indirect means. Directed biopsy taking has permitted a better characterization of the lesions. The use of power sources through the cholangiopancreatoscope means that it is now possible to fragment and remove refractory lithiases using traditional endoscopic systems. This document aims to define the advisable workflow when using a single-use, flexible cholangiopancreatoscope with the commercial name of SpyGlass®. Penning a set of guidelines to provide instructions on the technique, as well as tips and tricks related with the operation of these endoscopes will be a useful resource.
Assuntos
Doenças Biliares , Colangiopancreatografia Retrógrada Endoscópica , Endoscopia do Sistema Digestório , Desenho de Equipamento , Humanos , Ductos PancreáticosRESUMO
BACKGROUND: Small Bowel Capsule Endoscopy is the first-choice technique for investigating the majority of small bowel diseases. Its most common complications are related to incomplete examinations and capsule retention. There is no consensus on how patients with previous gastrointestinal surgery should receive the capsule. OBJECTIVE: The primary endpoint was to compare the rate of complete small-bowel examinations (completion rate) between oral ingestion and endoscopic delivery of the capsule. The secondary endpoint was to compare diagnostic yield and adverse events in the two groups. METHODS: A retrospective observational study was conducted in nine hospitals in Spain. Demographic data, previous surgery, indication for capsule endoscopy, intestinal transit time, diagnosis, completion rate (percentage of capsules reaching the caecum), diagnostic yield (percentage of results compatible with indication for the exam) and adverse events were collected. RESULTS: From January 2009 to May 2019 fifty-seven patients were included (39 male, mean age 66±15 years). The most common indications for the exam were "overt" (50.9%) and "occult" (35.1%) small bowel bleeding. Previous Billroth II gastrectomy and Roux-en-Y gastric bypass were present in 52.6% and 17.5% of patients respectively. The capsule was swallowed in 34 patients and placed endoscopically in 23 patients. No significant differences were observed between the oral ingestion and endoscopic delivery groups in terms of completion rate (82.4% vs. 78.3%; p=0.742), diagnostic yield (41.2% vs. 52.2%; p=0.432) or small bowel transit time (301 vs. 377min, p=0.118). No capsule retention occurred. Only one severe adverse event (anastomotic perforation) was observed in the endoscopic delivery group. CONCLUSIONS: In our case series, there were no significant differences between oral ingestion and endoscopic delivery in terms of completion rate, diagnostic yield or safety. Being less invasive, oral ingestion of the capsule should be the first-choice method in patients with previous gastrointestinal surgery.
Assuntos
Endoscopia por Cápsula , Procedimentos Cirúrgicos do Sistema Digestório , Enteropatias/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Idoso , Endoscopia por Cápsula/efeitos adversos , Endoscopia por Cápsula/estatística & dados numéricos , Ceco/diagnóstico por imagem , Deglutição , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Gastrectomia , Derivação Gástrica , Hemorragia Gastrointestinal/etiologia , Trânsito Gastrointestinal , Humanos , Masculino , Estudos Retrospectivos , EspanhaRESUMO
INTRODUCTION: Despite advances in imaging techniques, in many cases they are insufficient to establish the diagnosis of pancreatic cystic lesions (PCL). There are few publications in our setting that evaluate the combination of several methods obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). The aim of the study was to evaluate the overall utility of EUS-FNA in the diagnosis of PCL. MATERIAL AND METHODS: Retrospective study based on a database updated prospectively of a cohort of patients referred for EUS-FNA due to PCL detected in an imaging test. The sensitivity, specificity and diagnostic yield of carcinoembryonic antigen (CEA), cytology and viscosity were studied to detect mucinous lesions. RESULTS: From November 2013 to April 2018, 122 EUS were performed for PCL. EUS-FNA was performed in 94/122 (77%) and 21/122 (17.2%) patients were operated on. We included 33/122 patients who had diagnostic confirmation by histology, imaging (serous cyst with typical pattern) or clinical evolution. The study of the ROC curve determined the cutoff point ≥419 ng/ml to differentiate mucinous/non-mucinous cystic lesions. The diagnostic yield of CEA was 87.5% (21/24), cytology 81.8% (27/33) and viscosity 84.4% (27/32). The three parameters in combination obtained the best result (30/33, 90.9%). CONCLUSION: The combination of CEA analysis, cytology and viscosity of pancreatic fluid obtained by EUS-FNA increases the performance in the diagnosis of mucinous pancreatic cystic lesions, with it being greater than 90%.
Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Cisto Pancreático/patologia , Adulto , Idoso , Biomarcadores/análise , Antígeno Carcinoembrionário/análise , Carcinoma Ductal Pancreático/sangue , Carcinoma Ductal Pancreático/diagnóstico por imagem , Carcinoma Ductal Pancreático/patologia , Estudos de Coortes , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/estatística & dados numéricos , Feminino , Proteínas Ligadas por GPI/análise , Humanos , Masculino , Pessoa de Meia-Idade , Mucinas/química , Cisto Pancreático/sangue , Cisto Pancreático/diagnóstico por imagem , Cisto Pancreático/cirurgia , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , ViscosidadeRESUMO
BACKGROUND: The presence of hepatolithiasis (HL) is prevalent in eastern countries. It is a clinical entity which is rarely reported in non-surgical series because the standard treatment is the surgical option. Currently, treatment has evolved, with the use of endoscopic techniques being increased and the number of hepatectomies being decreased. SpyGlass™ is a small-calibre endoscopic direct cholangiopancreatoscopy developed to explore and perform procedures in the bile and pancreatic ducts. Single-operator peroral cholangioscopy (POC) is an endoscopic technique useful for treating difficult bile duct stones. AIMS: To assess the usefulness, efficacy, and safety of POC with the SpyGlass™ system in patients with HL. PRIMARY OBJECTIVES: to achieve technical success of the procedure and clinical success of patients with HL. STUDY DESIGN AND PATIENTS: Retrospective, single-centre cohort study of patients with HL from April 2012 to August 2018. SpyGlass™ was chosen in symptomatic patients referred from the surgery unit as the first-line procedure. To perform electrohydraulic lithotripsy (EHL), we used a Northgate Autolith IEHL generator with a 0.66-mm biliary probe. RESULTS: We performed a total of 13 procedures in 7 patients with HL. The mean age was 46 years (range 35-65) and 3/7 of patients were female. We achieved technical success in 5/7 cases (71.4%) and clinical success in 4/7 cases (57%). DISCUSSION: SpyGlass™ is safe and effective in the treatment of HL. With these results, we confirm the need for management of patients with HL in a multidisciplinary team. When the endoscopic approach is the option, this procedure must be performed by experts in advanced endoscopy.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Colelitíase/terapia , Endoscópios , Litotripsia/métodos , Hepatopatias/terapia , Adulto , Idoso , Colelitíase/diagnóstico por imagem , Feminino , Humanos , Litotripsia/instrumentação , Hepatopatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
A 54-year-old female patient was referred to our outpatient clinic in December 2017 due to unresolved epigastric pain. She underwent cholecystectomyin in October 2012 due to epigastric pain, without evidence of lithiasis or biliary sludge. Subsequently, the patient continued to present epigastric discomfort with episodes of epigastralgia and was admitted in August 2016. There was evidence of elevated transaminases AST 125, ALT 97 and GGT 47, with normal amylase and no specific diagnosis was made on discharge from hospital.
Assuntos
Doenças dos Ductos Biliares/diagnóstico por imagem , Endossonografia , Hamartoma/diagnóstico por imagem , Doenças dos Ductos Biliares/patologia , Feminino , Hamartoma/patologia , Humanos , Pessoa de Meia-IdadeRESUMO
We present the case of a 76-year-old male who underwent arthrodesis due to a C7 fracture, which was complicated by an esophageal perforation and required primary surgical closure.
Assuntos
Vértebras Cervicais/lesões , Perfuração Esofágica/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Idoso , Vértebras Cervicais/diagnóstico por imagem , Perfuração Esofágica/etiologia , Esôfago/diagnóstico por imagem , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico por imagem , Gastroscopia , Humanos , Masculino , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Most extrahepatic cholangiocarcinomas are unresectable at the time of diagnosis and even in case of a resectable cancer, surgery is not an option for the elderly or patients with comorbidities (1). Current treatment alternatives in these scenarios are very limited. Biliary stenting with self-expanding metal stents (SEMS) is the mainstay palliative treatment for biliary obstruction (2). However, emerging experience with endoscopic RF ablation (RFA) in this setting has been reported in the literature.
Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Ablação por Cateter/métodos , Colangiocarcinoma/cirurgia , Adulto , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Colangiocarcinoma/diagnóstico por imagem , Colangiopancreatografia Retrógrada Endoscópica , Humanos , Hipertensão Portal/terapia , Masculino , Ablação por Radiofrequência/métodosRESUMO
BACKGROUND AND OBJECTIVES: endoscopic septotomy of the cricopharyngeal muscle (ESCM) is a technique used for the treatment of Zenker's diverticulum (ZD). The experience with computerized vascular sealing systems (LigaSure® type) is limited. The objective of this study was to evaluate the efficacy and safety of ESCM using LigaSure®. METHODS: this was a long-term prospective study of 18 patients with ZD, who were referred to our hospital due to ESCM between 2010 and 2016. The severity of the symptoms was determined using the Dakkak-Bennett validated scale for dysphagia and the rest with numerical scales. The rates of relapse and retreatment were evaluated. RESULTS: ESCM with LigaSure® was performed in 17 cases, one case was excluded due to technical difficulties. The median age was 72 years and regurgitation, dysphagia and respiratory symptoms were found in 100%, 89% and 56% of cases, respectively. The median size of the diverticulum was 28 mm (20-60 mm). The median time of the procedure was 35 minutes (25-45 minutes). There were four complications, two hemorrhages and two perforations. The median follow-up was 13 months (range: 12-82 months). Clinical improvements were observed for all symptoms and were maintained 12 months after treatment (p < 0.05). There was no relapse during follow-up in 13 patients. A complete section was not achieved and clinical relapse occurred after a median time of seven months that required retreatment in the remaining patients. CONCLUSIONS: ESCM with LigaSure® may be a safe and effective technique in long-term follow-up situations, with low rates of relapse.
Assuntos
Eletrocirurgia , Esfíncter Esofágico Superior/cirurgia , Esofagoscopia , Divertículo de Zenker/cirurgia , Idoso , Idoso de 80 Anos ou mais , Eletrocirurgia/efeitos adversos , Esofagoscopia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
Digestive endoscopy is the most effective tool available for the diagnosis of multiple gastrointestinal (GI) tract conditions, and it represents a key aspect in the training of gastroenterology residents according to the Spanish MIR (médico interno residente) program. The Sociedad Española de Endoscopia Digestiva (SEED), aware of all the technical advances that have emerged during the past few years, deems it necessary to define a program of the skills specialists-in-training in gastroenterology should acquire during their residency. This paper describes the goals of endoscopy training, the techniques that should be mastered, and the diagnostic and therapeutic skills this specialty requires. Finally, a model is suggested for the assessment of competence.
Assuntos
Competência Clínica , Currículo , Endoscopia Gastrointestinal/educação , Gastroenterologia/educação , Internato e Residência , Humanos , Sociedades Médicas , EspanhaRESUMO
INTRODUCCIóN: Adherence to guidelines on the periendoscopic management of antiplatelet therapy (APT) has not been analyzed in detail. Our aim was to assess adherence to guidelines in patients referred to our Endoscopy Unit on a case-by-case basis, describing in detail the detected deviations and identifying areas of improvement. PATIENTS AND METHODS: Cross-sectional study of outpatients consecutively scheduled for an unsedated upper or lower gastrointestinal endoscopy between January and June 2015. Patients on anticoagulant therapy were excluded. RESULTS: 675 patients were evaluated, including 91 (13.5%) patients on APT [upper GI endoscopy 25 (27.5%), lower GI endoscopy 66 (72.5%)]. Contrary to the clinical guidelines, aspirin was discontinued in 25 of the 77 patients previously prescribed the drug (32.5%) but this modification was patient's own decision in 11 cases. Most of the apparent deviations in the management of clopidogrel and dual antiplatelet therapy (DAPT) were not true non-adherence cases. The Primary Care physician modified an APT prescribed by another physician in 8 of 9 cases (88.9%), always in cases with aspirin. No relationship was found between the endoscopic procedure's predicted risk of bleeding or the patient's thrombotic risk and modification of therapy. DISCUSSION: In many patients, the peri-procedural management of APT goes against current guidelines, but some of these inconsistencies cannot be considered true deviations from practice. Identified areas for improvement are increasing patient awareness about APT, disseminating the guidelines in Primary Care, and underscoring the significance of thrombotic risk related to APT withdrawal.
Assuntos
Endoscopia Gastrointestinal , Fidelidade a Diretrizes , Inibidores da Agregação Plaquetária/administração & dosagem , Guias de Prática Clínica como Assunto , Adulto , Idoso , Idoso de 80 Anos ou mais , Aspirina/administração & dosagem , Aspirina/efeitos adversos , Clopidogrel/administração & dosagem , Clopidogrel/efeitos adversos , Colonoscopia , Contraindicações de Medicamentos , Estudos Transversais , Feminino , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/efeitos adversos , Estudos ProspectivosRESUMO
BACKGROUND AND AIM: The role of capsule endoscopy (CE) in established celiac disease (CD) remains unclear. Our objective was to analyze the usefulness of CE in the suspicion of complicated CD. METHODS: This was a retrospective multicenter study. One hundred and eighty-nine celiac patients (mean age: 46.6 ± 16.6, 30.2% males) who underwent CE for alarm symptoms (n = 86, 45.5%) or non-responsive CD (n = 103, 54.5%) were included. Diagnostic yield (DY), therapeutic impact and safety were analyzed. RESULTS: Capsule endoscopy was completed in 95.2% of patients (small bowel transit time: 270.5 ± 100.2 min). Global DY was 67.2%, detecting atrophic mucosa (n = 92, 48.7%), ulcerative jejunoileitis (n = 21, 11.1%), intestinal lymphoma (n = 7, 3.7%) and other enteropathies (n = 7, 3.7%, six Crohn's disease cases and one neuroendocrine tumor). The DY of CE was significantly higher in patients presenting with non-responsive disease compared to patients with alarm symptoms (73.8% vs 59.3%, P = 0.035). The new findings of the CE modified management in 59.3% of the cases. There were no major complications. CONCLUSION: Capsule endoscopy may be a moderately helpful and safe diagnostic tool in the suspicion of complicated CD, modifying the clinical course of these patients.
Assuntos
Endoscopia por Cápsula/métodos , Doença Celíaca/diagnóstico , Dieta Livre de Glúten , Mucosa Intestinal/patologia , Adulto , Doença Celíaca/dietoterapia , Estudos de Coortes , Progressão da Doença , Feminino , Seguimentos , Humanos , Intestino Delgado/patologia , Intestino Delgado/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Adulto JovemRESUMO
BACKGROUND AND AIMS: to assess the usefulness, efficacy and safety of single-operator cholangiopancreatoscopy (SOCP) with the SpyGlass™ system for the management of biliopancreatic diseases. METHODS: a retrospective analysis of patients undergoing SOCP with the SpyGlass™ between September 2008 and April 2016 was performed. Data was obtained from a prospectively-maintained database at a tertiary referral center. The primary study outcomes were technical and complete endoscopic success of the procedure. Two different SpyGlass™ systems were employed; the former is called legacy and the latter, digital system (DS). RESULTS: a total of 107 SOCP procedures in 93 patients performed by a single operator were analyzed. Technical success of the SpyGlass™ examination was achieved in 90/93 (97%) of patients and complete success by resolving the biliopancreatic condition in 82/93 (88%) cases. In indeterminate biliary strictures, a complete success was achieved in 45/52 (85%) of cases. With regard to stone treatment, technical success was achieved in 34/34 (100%) patients and complete success, in 31/34 (91%) cases. Electrohydraulic lithotripsy was applied in 16/34 (47%) of cases. There were a total of 7/93 adverse effects (7.5%). CONCLUSIONS: SOCP is a useful and safe technique for the treatment of biliopancreatic diseases with a low rate of adverse effects. The procedure seems technically demanding and dedication is required.