Cholangioscopy-guided lithotripsy for difficult bile duct stone clearance in a single session of ERCP: results from a large multinational registry demonstrate high success rates.
Endoscopy
; 51(10): 922-929, 2019 10.
Article
in En
| MEDLINE
| ID: mdl-31250408
BACKGROUND: Peroral cholangioscopy (POCS) can be useful for difficult bile duct stone clearance. Large prospective multinational data on POCS-guided lithotripsy for clearing difficult bile duct stones in a single session of endoscopic retrograde cholangiopancreatography (ERCP) are missing. METHODS: Patients with difficult bile duct stones (defined as one or more of: largest stone diameter ≥â15âmm, failed prior attempt at stone clearance, impacted, multiple, hepatic duct location, or located above a stricture) were enrolled at 17 centers in 10 countries. The principal endpoint was stone clearance in a single ERCP procedure using POCS. RESULTS : 156 patients underwent 174 sessions of POCS-guided electrohydraulic or laser lithotripsy. Stone clearance had failed in a previous ERCP using traditional techniques in 124/156 patients (80â%), while 32â/156 patients (21â%) were referred directly to POCS-guided therapy based on preprocedural assessment of the difficulty of stone clearance. In 101/156 patients (65â%), there were impacted stones. POCS-guided stone clearance was achieved in a single POCS procedure in 125â/156 patients (80â%, 95â% confidence interval [CI] 73â%â-â86â%), and was significantly more likely for stones ≤â30âmm compared with >â30âmm (odds ratio 7.9, 95â%CI 2.4â-â26.2; Pâ=â0.002). Serious adverse events occurred in 3/156 patients (1.9â%, 95â%CI 0.4â%â-â5.5â%), and included pancreatitis, perforation due to laser lithotripsy, and cholangitis (nâ=â1 each), all resolved within 1 week. CONCLUSION: POCS-guided lithotripsy is highly effective for clearance of difficult bile duct stones in a single procedure and successfully salvages most prior treatment failures. It may also be considered first-line therapy for patients with difficult choledocholithiasis to avoid serial procedures.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Lithotripsy
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Gallstones
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Cholangiopancreatography, Endoscopic Retrograde
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Natural Orifice Endoscopic Surgery
Type of study:
Clinical_trials
/
Diagnostic_studies
/
Observational_studies
Limits:
Aged
/
Female
/
Humans
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Male
/
Middle aged
Language:
En
Journal:
Endoscopy
Year:
2019
Document type:
Article
Affiliation country:
India
Country of publication:
Germany