Acuña PR

Language: Spanish
References: 20
Page: 222-228
PDF size: 1111.08 Kb.

ABSTRACT

Introduction: some stones, due to their size, number, or geometry, are impossible to treat using conventional endoscopic methods such as endoscopic retrograde cholangiopancreatography (ERCP). Objective: to review the type of stone and the management of difficult-to-manage choledocholithiasis at a tertiary care hospital using endoscopic cholangioscopy and intraductal lithotripsy through a retrospective, observational, and cross-sectional review of a case series. Material and methods: analysis of a case series of difficult choledocholithiasis treated between October 21, 2016, and December 31, 2019. Demographic characteristics, stone type, number of previous failed ERCPs, resolution rate using cholangioscopy and lithotripsy, complications, and mortality were recorded. Results: fourteen patients were treated, of whom two (14%) were male and twelve (86%) were female. The median age was 73 years (range 25-89), with a mean age of 62.7 years. Nine patients (64.3%) had undergone previous ERCP: five (35.7%) had undergone one ERCP, two (14.3%) had undergone two ERCPs, and two (14.3%) had undergone three ERCPs. One woman (7%), 26 weeks pregnant with three previous hospitalizations for pain, was included in this series to avoid radiation exposure, after consultation with the gynecology department. Choledocholithiasis was successfully resolved by cholangioscopy and lithotripsy in all patients, requiring one session in 12 (86%) patients and two (14%) in two. The stone size in all cases was 2 cm or larger; the number of stones was one to five in seven (50%) patients, six to ten in three (21%) patients, and more than ten stones in four (29%) patients. As a complication, two (14.3%) patients developed mild acute pancreatitis post-lithotripsy, which resolved within 48 hours. There was no mortality in this case series. Conclusion: cholangioscopy with lithotripsy allowed for the resolution of choledocholithiasis in very complex cases in one or two sessions, making it a good therapeutic option for difficult stones, as all patients presented with multiple choledocholithiasis and large primary biliary tract stones in 13 (93%) of the cases.

REFERENCES

1. Nakajima M, Akasaka Y, Yamaguchi K. Direct endoscopic in a biliaryvisualization of the bile and pancreatic duct systems by peroral cholangiopancreatoscopy (PCPS). Gastrointest Endosc. 1978; 24: 141-145.

2. Ponchon T, Gagnon P, Valette PJ. Pulsed dye laser lithotripsy of the bile duct stones. Gastroenterology. 1991; 100: 1730-1736.

3. Chen YK, Parsi MA, Binmoeller KF. Single-operator cholangioscopy in patients requiring evaluation of the bile duct disease or therapy of biliary stones (with videos). Gastrointest Endosc. 2011; 74: 805-814.

4. Chen YK, Pleskow DK. SpyGlass single-operator cholangiopancreatoscopy system for the diagnosis and therapy of bile-duct disorders: a clinical feasibility study (with video). Gastrointest Endosc. 2007; 65: 832-841.

5. Shah RJ, Neuhaus H, Parsi M. A randomized assessment of a semidisposable digital single operator cholangioscope in a biliary tract bench model. Endosc Int Open. 2018; 6: E851-E856.

6. Parsi MA, Jang S, Sanaka M, et al. Diagnostic and therapeutic cholangiopancreatoscopy: performance of a new digital cholangioscope. Gastrointest Endosc. 2014; 79: 936-942.

7. Cotton PB, Elsen GM, Aabakken L. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010; 71: 446-454.

8. Navaneethan U, Hasan MK, Lourdusamy V. Single operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review. Gastrointest Endosc. 2015; 82: 608-614.

9. Itoi T, Sofuni A, Itokawa F. Peroral cholangioscopy diagnosis of biliary-tract diseases by using narrow band imaging (with video). Gastrointest Endosc. 2007; 66: 730-736.

10. Parsi MA, Stevens T, Collins J. Utility of a prototype peroral video cholangioscopy system with narrow- band Imaging for evaluation of biliary disorders (with videos). Gastrointet Endosc. 2011; 74: 1148-1151.

11. Kim HJ, Kim Mh, Lee SK. Tumor Vessels: a valuable cholangioscopic clue of malignant biliary stricture. Gastrointest Endosc. 2011; 74: 635-638.

12. Seeholf A, Shumacher B, Neuhaus H. Prospective study of SpyGlass guided laser lithotripsy of bile duct stones after failure of conventional endoscopic techniques (abstract). Gastrointest Endos. 2009; 69: AB261.

13. Attwell AR, Patel S, Kahaleh M. ERCP with peroral pancreatoscopy-guided laser lithotrpsy for calcific chronic pancreatitis: a multicenter US experience. Gastrointest Endosc. 2015; 82: 311-318.

14. Shah RJ, Raijman I, Brauer BC. A US multicenter first human use experience using the fully disposable, digital single operator cholangioscope (DSOCP) (abstract). Gastrointest Endosc. 2016; 83: AB 141.

15. Manta R, Frazzoni M, Conigliaro R. SpyGlass single-operator peroral cholangiography in the evaluation of indeterminate biliary lessions: a single center, prospective cohort study. Surg Endosc. 2013; 27: 1569-1572.

16. Ishida V,Itol T,Okade Y. Can image -enhanced cholangioscopy distinguish beningn from malignant lesions in the biliary duct? Best Pract Res Clin Gastroenterol. 2015; 29: 611-625.

17. Tringall A, Lemmers A, Meves V. Intraductal biliopancreatic imaging: European Society of Gastrointest Endoscopy (ESGE) technology review. Endoscopy. 2015; 47: 739-753.

18. Sha RJ. Innovations in intraductal endoscopy cholangioscopy and pancreatoscopy. Gastrointest Endosc Clin N Am. 2015; 25; 779-92.

19. Wright ER, Bakis G, Srinnivasan R. Intraprocedural tissue diagnosis during ERCP employing a new cytology preparation forceps biopsy (Smash protocol). Am J Gastroenterol. 2011; 106: 294-299.

20. Seithi A, Doukides T, Seipal DV. Interobserver agreement for single operator choledocoscopy imaging; can we do better? Diagn Ther Endosc. 2014; 2014: 730731.