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Amaral AC, Hussain WK, Han S. Cholangioscopy-guided electrohydraulic lithotripsy versus laser lithotripsy for the treatment of choledocholithiasis: a systematic review. Scand J Gastroenterol 2023; 58:1213-1220. [PMID: 37203215 DOI: 10.1080/00365521.2023.2214657] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Endoscopic management of large bile duct stones may be challenging and refractory to standard endoscopic retrograde cholangiopancreatography (ERCP) techniques. To this end, per-oral cholangioscopy (POC)-guided electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL) has been increasingly utilized during ERCP. There are limited data, however, comparing EHL and LL in the management of choledocholithiasis. Therefore, the aim was to analyze and compare the efficacy of POC-guided EHL and LL for the treatment of choledocholithiasis. METHODS A database search on PubMed was performed selecting prospective English-language articles published by September 20th, 2022, in accordance with PRISMA guidelines. Studies selected included bile duct clearance as an outcome. RESULTS A total of 21 prospective studies (15 using LL, 4 using EHL, and 2 both) including 726 patients were included for analysis. Complete ductal clearance was achieved in 639 (88%) patients with 87 (12%) patients having incomplete ductal clearance. Patients treated with LL had an overall median stone clearance success rate of 91.0% (IQR, 82.7-95.5), whereas EHL achieved a median stone clearance success rate of 75.8% (IQR, 74.0-82.4), [p = .03]. CONCLUSIONS LL is a highly effective form of POC-guided lithotripsy for the treatment of large bile duct stones, particularly when compared to EHL. However, direct, head-to-head randomized trials are needed to identify the most effective form of lithotripsy for treating refractory choledocholithiasis.
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Affiliation(s)
- Anna Cecilia Amaral
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Waleed K Hussain
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Samuel Han
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Hammoudi N, Brieau B, Barret M, Bordacahar B, Leblanc S, Coriat R, Chaussade S, Prat F. Mirizzi's syndrome in Roux-en-Y bypass patient successfully treated with cholangioscopically-guided laser lithotripsy via percutaneous gastrostomy. Endosc Int Open 2018; 6:E826-E829. [PMID: 29978001 PMCID: PMC6032633 DOI: 10.1055/a-0609-6448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 03/13/2018] [Indexed: 11/30/2022] Open
Abstract
Obesity and bariatric surgery are major risk factors in gallstone disease. In patients with a past history of Roux-en-Y gastric bypass, Mirizzi's syndrome is a challenging endoscopic situation because of the modified anatomy. Here we report the first case of a patient with a Roux-en-Y gastric bypass treated by intracorporeal lithotripsy with a digital single-operator cholangioscope following an endoscopic retrograde cholangiopancreatography (ERCP) using a percutaneous gastrostomy access.
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Affiliation(s)
- Nassim Hammoudi
- Service de gastroentérologie et endoscopie digestive, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75014 Paris, France
| | - Bertrand Brieau
- Service de gastroentérologie et endoscopie digestive, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75014 Paris, France,Corresponding author Bertrand Brieau, MD Service de gastroentérologie et endoscopie digestiveHôpital CochinUniversité Paris Descartes27 rue du Faubourg Saint Jacques75014 ParisFrance+33-1-58411930
| | - Maximilien Barret
- Service de gastroentérologie et endoscopie digestive, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75014 Paris, France,Unité INSERM 1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Benoit Bordacahar
- Service de gastroentérologie et endoscopie digestive, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75014 Paris, France
| | - Sarah Leblanc
- Service de gastroentérologie et endoscopie digestive, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75014 Paris, France
| | - Romain Coriat
- Service de gastroentérologie et endoscopie digestive, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75014 Paris, France,Unité INSERM 1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Stanislas Chaussade
- Service de gastroentérologie et endoscopie digestive, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75014 Paris, France,Unité INSERM 1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Frédéric Prat
- Service de gastroentérologie et endoscopie digestive, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75014 Paris, France,Unité INSERM 1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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3
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Shuaib A, Kokaj J, Makdisi Y, Pichler G, Husain A, Asfar S. Time-Resolved Laser-Induced Fluorescence Spectroscopy as a Guidance Tool for Laser Lithotripsy of Gallbladder Stones. Photomed Laser Surg 2017; 35:498-504. [PMID: 28727952 DOI: 10.1089/pho.2017.4271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Although laser lithotripsy for fragmentation of gallbladder stones has been applied successfully in many clinical situations, this approach has two major limitations: (1) the potential to damage or perforate the bile duct and (2) the efficiency can be affected by the chemical composition of the gallstones. The present study evaluated the use of time-resolved laser-induced fluorescence spectroscopy to classify stone types and distinguish stone from tissue. MATERIALS AND METHODS Ex vivo time-resolved laser-induced fluorescence analysis (excitation wavelength λex = 400 nm and emission wavelength = 450-700 nm) of 54 gallbladder stones and seven gallbladder tissue samples was conducted. The spectral and temporal parameters were analyzed using linear discrimination analysis (LDA) to differentiate stone from tissue and to classify different stone types using two wavelength regions (λ1 = 510-530 nm and λ2 = 550-570 nm). RESULTS Examination of 54 gallbladder stones and seven gallbladder tissue samples showed a significant difference in spectral- and temporal-derived parameters. The data were classified using LDA, and the overall accuracy was 94.88%, 84.39%, and 85.79% for both spectral and temporal parameters, only spectral parameters, and only temporal parameters, respectively. CONCLUSIONS Our findings establish the feasibility of using time-resolved laser-induced fluorescence spectroscopy as a tool to identify gallbladder stone types and as a stone-tissue detection system to improve the effectiveness of laser lithotripsy procedures and reduce the risk of damaging biliary tract tissues.
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Affiliation(s)
- Ali Shuaib
- 1 Biomedical Engineering Unit, Department of Physiology, Faculty of Medicine, Kuwait University , Kuwait
| | - Jahja Kokaj
- 2 Department of Physics, Faculty of Science, Kuwait University , Kuwait
| | - Yacoub Makdisi
- 2 Department of Physics, Faculty of Science, Kuwait University , Kuwait
| | - Goran Pichler
- 2 Department of Physics, Faculty of Science, Kuwait University , Kuwait
| | - Abdullah Husain
- 3 Department of Surgery, Mubarak Al-Kabeer Hospital , Jabirya, Kuwait
| | - Sami Asfar
- 3 Department of Surgery, Mubarak Al-Kabeer Hospital , Jabirya, Kuwait .,4 Department of Surgery, Faculty of Medicine, Kuwait University , Kuwait
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Karsenti D. Endoscopic management of bile duct stones: residual bile duct stones after surgery, cholangitis, and "difficult stones". J Visc Surg 2013; 150:S39-46. [PMID: 23817008 DOI: 10.1016/j.jviscsurg.2013.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Endoscopic treatment has become, according to the latest recommendations, the standard treatment for common bile duct stones (CBDS), although in certain situations, surgical clearance of the common duct at the time of laparoscopic cholecystectomy is still considered a possible alternative. The purpose of this article is not to compare endoscopic with surgical treatment of CBDS, but to describe the various techniques of endoscopic treatment, detailing their preferential indications and the various treatment options that must sometimes be considered when faced with "difficult calculi" of the CBD. The different techniques of lithotripsy and the role of biliary drainage with plastic or metallic stents will be detailed as well as papillary balloon dilatation and particularly the technique of sphincterotomy with macrodilatation of the sphincter of Oddi (SMSO), a recently described approach that has changed the strategy for endoscopic management of CBDS. Finally, the overall strategy for endoscopic management of CBDS, with description of different techniques, will be exposed.
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Affiliation(s)
- D Karsenti
- Digestive Endoscopic Unit, Clinique de Bercy, 9, quai de Bercy, 94220 Charenton-le Pont, France.
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Nakaji S, Hirata N, Shiratori T, Kobayashi M, Inase M. Endoscopic lithotripsy with peroral direct cholangioscopy using a conventional endoscope. World J Gastrointest Endosc 2013; 5:132-4. [PMID: 23515588 PMCID: PMC3600550 DOI: 10.4253/wjge.v5.i3.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 09/06/2012] [Accepted: 12/22/2012] [Indexed: 02/05/2023] Open
Abstract
Recently, peroral direct cholangioscopy (PDCS) using an ultra-slim endoscope has come into the spotlight. However, the working channel is too small to use various devices for lithotripsy. We report a case of endoscopic lithotripsy with PDCS using a conventional endoscope as a cholangioscope. Computed tomography scan on an 80-year-old female who was admitted with acute cholangitis showed two large stones in the bile duct. Endoscopic retrograde cholangiopancreatography was attempted first. However, mechanical lithotripsy failed because the stone was too large for the basket catheter. Finally, electric hydraulic lithotripsy with PDCS using a conventional endoscope was performed allowed the stones to be cleared completely. In conclusion, PDCS using a conventional endoscope can be an alternative solution for endoscopic lithotripsy for patients with large stones in the dilated bile duct.
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Affiliation(s)
- So Nakaji
- So Nakaji, Nobuto Hirata, Toshiyasu Shiratori, Masayoshi Kobayashi, Masami Inase, Department of Gastroenterology, Kameda Medical Center, Kamogawa city, Chiba 296-8602, Japan
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Chung HJ, Jeong S, Lee DH, Lee JI, Lee JW, Bang BW, Kwon KS, Kim HK, Shin YW, Kim YS. Giant choledocholithiasis treated by mechanical lithotripsy using a gastric bezoar basket. World J Gastroenterol 2012; 18:3327-30. [PMID: 22783060 PMCID: PMC3391773 DOI: 10.3748/wjg.v18.i25.3327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 11/21/2011] [Accepted: 11/28/2011] [Indexed: 02/06/2023] Open
Abstract
Mechanical lithotripsy (ML) is usually considered as a standard treatment option for large bile duct stones. However, it is impossible to retrieve oversized stones because the conventional lithotripsy basket may not be able to grasp the stone. However, there is no established endoscopic extraction method for such giant stone removal. We describe a case of successful extraction of a 4-cm large stone using a gastric bezoar basket. A 78-year-old woman had suffered from upper abdominal pain for 20 d. Contrast-enhanced computed tomogram revealed a 4-cm single stone in the distal common bile duct (CBD). Endoscopic stone retraction was decided upon and endoscopic papillary balloon dilation was performed using a large balloon. An attempt to capture the stone using a standard lithotripsy basket failed due to the large stone size. Subsequently, we used a gastric bezoar basket to successfully capture the stone. The stone was fragmented into small pieces and extracted. The stone was completely removed after two sessions of endoscopic retrograde cholangiopancreatography; each of which took 30 min. No complications occurred during or after the procedure. The patient was fully recovered and discharged on day 11 of hospitalization. ML using a gastric bezoar basket is a safe and effective retrieval method in select cases, and is considered as an alternative nonoperative option for the management of difficult CBD stones.
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Diagnostic and therapeutic utility of single-operator peroral cholangioscopy for indeterminate biliary lesions and bile duct stones. Eur J Gastroenterol Hepatol 2012; 24:656-64. [PMID: 22433791 DOI: 10.1097/meg.0b013e3283526fa1] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM We aimed to evaluate the diagnostic utility of single-operator peroral cholangioscopy (SOC) for indeterminate biliary lesions and its usefulness in electrohydraulic lithotripsy (EHL) of biliary stones not amenable to conventional endoscopic therapy. PATIENTS AND METHODS All patients undergoing SpyGlass SOC in four UK tertiary centres between 2008 and 2010 were retrospectively enrolled. Patients were followed up until death or the last clinic visit until May 2011. The operating characteristics of SOC for detecting malignant lesions and the stone clearance rate after SOC-guided EHL were calculated. RESULTS A total of 165 patients underwent 179 SOC procedures. Sixty-six percent were referred for indeterminate biliary strictures, 13% for filling defects and 21% for SOC-guided EHL. Cannulation with the SOC system was successful in 95% but visualization was inadequate in 13%. Primary sclerosing cholangitis was a risk factor for failed cannulation and conscious sedation (vs. general anaesthesia) for inadequate visualization (P<0.05). The accuracy of SOC for diagnosing malignant lesions was 87%. SOC-guided biopsies were adequate in 72%. Obtaining at least four versus less than four biopsy specimens resulted more often in adequate samples (90 vs. 64%, P=0.037). Complete stone clearance could be achieved in 73% of patients. The adverse event rate was 9.6%. Cholangitis was the most common event (56%, one fatal). CONCLUSION SOC is useful for the differential diagnosis of indeterminate biliary lesions and the treatment of 'difficult' biliary stones. The adequacy of SOC-guided biopsies is related to the number of specimens obtained. Primary sclerosing cholangitis is related to failed cannulation with the SOC system, whereas general anaesthesia is related to adequate visualization.
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8
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Maydeo A, Kwek BEA, Bhandari S, Bapat M, Dhir V. Single-operator cholangioscopy-guided laser lithotripsy in patients with difficult biliary and pancreatic ductal stones (with videos). Gastrointest Endosc 2011; 74:1308-1314. [PMID: 22136776 DOI: 10.1016/j.gie.2011.08.047] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 08/23/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Scant data exist on the utility of the holmium:yttrium-aluminum-garnet laser for the treatment of biliary or pancreatic duct stones. OBJECTIVE To evaluate the efficacy and safety of fiberoptic probe and catheter system-guided holmium laser lithotripsy of difficult biliary and pancreatic duct stones. DESIGN Prospective study. SETTING Tertiary-care referral center. PATIENTS This study involved 64 patients who underwent holmium laser stone fragmentation. INTERVENTION A total of 64 patients (60 bile duct stones, 4 pancreatic duct stones) underwent endoscopic retrograde stone fragmentation with a holmium laser and a fiberoptic probe and catheter system. The inclusion criterion for bile duct stones was stones not amenable to retrieval by mechanical lithotripsy and/or balloon sphincteroplasty or standard techniques. Pancreatic duct stones included in this study were not amenable to removal by stone retrieval basket or balloon. MAIN OUTCOME MEASUREMENTS Rates of ductal clearance and procedural complications. RESULTS All 64 patients had successful fragmentation of biliary and pancreatic duct stones with the holmium laser. Fifty of 60 patients (83.3%) had complete biliary duct clearance after a single session; 10 patients required an additional session. All pancreatic duct stones were fragmented in a single session. Mean duration of ERCP sessions was 45.9 minutes (range 30-90 minutes). Complications were mild and were encountered in 13.5% of patients; fever (n = 3), transient abdominal pain (n = 4), and biliary stricture (n = 1). LIMITATIONS No comparative treatment group. CONCLUSION The fiberoptic probe and catheter system facilitates transpapillary access for holmium laser fragmentation of difficult biliary and pancreatic duct stones. The technique is safe and highly effective for single-setting duct clearance. Complications are minimal and transient.
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Affiliation(s)
- Amit Maydeo
- Institute of Advanced Endoscopy, Mumbai, India.
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9
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Lee TY, Cheon YK, Choe WH, Shim CS. Direct cholangioscopy-based holmium laser lithotripsy of difficult bile duct stones by using an ultrathin upper endoscope without a separate biliary irrigating catheter. Photomed Laser Surg 2011; 30:31-6. [PMID: 22043820 DOI: 10.1089/pho.2011.3094] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE We investigated the impact of direct peroral cholangioscopy (POC)-based holmium laser lithotripsy using an ultrathin endoscope with direct irrigation via a 2-mm-diameter working channel to remove difficult common bile duct (CBD) stones without a separate biliary catheter. BACKGROUND DATA Few clinical studies have reported the successful removal of difficult CBD stones by direct POC-based laser lithotripsy using an ultrathin upper endoscope. Previous studies used a separate biliary catheter to ensure continuous irrigation. METHODS Ten patients (6 males; mean age 63.3 years) with difficult CBD stones who were not amenable to conventional endoscopic procedures were examined. Direct POC using an ultrathin upper endoscope was performed in all patients. Holmium laser lithotripsy with direct saline irrigation via the operating channel of an ultrathin endoscope was performed until stone fragments were captured in a basket. RESULTS The overall success rate of bile duct clearance was 90% (9 of 10 patients) and the mean number of treatment sessions was 1.2 (range, 1-2). Mechanical lithotripsy was performed to complete stone removal in one patient (10%) who had a distal CBD stricture. One patient experienced mild cholangitis following laser lithotripsy. CONCLUSIONS Holmium laser lithotripsy under direct POC using an ultrathin upper endoscope may be an effective and safe technique for removal of difficult CBD stones. Direct irrigation via the 2-mm-diameter working channel of the ultrathin endoscope provides sufficient fluid medium and affords good endoscopic viewing to assure stone fragmentation without any need for a separate biliary catheter.
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Affiliation(s)
- Tae Yoon Lee
- Digestive Disease Center, Konkuk University Medical Center, Konkuk University School of Medicine, Hwayangdong, Gwangjingiu, Seoul, Korea
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10
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The role of endoscopy in the management of choledocholithiasis. Gastrointest Endosc 2011; 74:731-44. [PMID: 21951472 DOI: 10.1016/j.gie.2011.04.012] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 04/06/2011] [Indexed: 12/15/2022]
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Itoi T, Sofuni A, Itokawa F, Shinohara Y, Moriyasu F, Tsuchida A. Evaluation of residual bile duct stones by peroral cholangioscopy in comparison with balloon-cholangiography. Dig Endosc 2010; 22 Suppl 1:S85-9. [PMID: 20590779 DOI: 10.1111/j.1443-1661.2010.00954.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We evaluated the usefulness of peroral cholangioscopy (POCS) for residual bile duct stones in patients with complete bile duct clearance confirmed by balloon-occluded cholangiography. A total of 108 patients with common bile duct stones who underwent POCS after extraction of stones via endoscopic sphincterotomy, resulting in complete bile duct extraction confirmed by balloon-occluded cholangiography, were retrospectively evaluated. For the treatment of difficult stones, stones were fragmented by mechanical lithotripsy (ML) or electrohydraulic lithotripsy (EHL). In 26 patients (24%), residual stones were detected with POCS in the lower bile duct. In patients with residual stones, large bile duct stones, juxtapapillary diverticulum, and use of ML or EHL were significantly related to residual stones (P < 0.05). Although a prospective study is necessary to clarify whether this procedure is appropriate in aspects of cost and benefits, POCS appears to be a useful diagnostic tool for confirming complete extraction of bile duct stones. POCS may be useful, particularly when lithotripsy using ML or EHL is performed and a large pneumobilia exists in the bile duct.
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Affiliation(s)
- Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
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12
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Nguyen NQ, Binmoeller KF, Shah JN. Cholangioscopy and pancreatoscopy (with videos). Gastrointest Endosc 2009; 70:1200-10. [PMID: 19863954 DOI: 10.1016/j.gie.2009.07.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 07/05/2009] [Indexed: 02/08/2023]
Affiliation(s)
- Nam Q Nguyen
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California 94115, USA
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13
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Day A, Sayegh ME, Kastner C, Liston T. The use of holmium laser technology for the treatment of refractory common bile duct stones, with a short review of the relevant literature. Surg Innov 2009; 16:169-72. [PMID: 19546123 DOI: 10.1177/1553350609338373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The treatment of common bile duct (CBD) stones can vary in complexity and many methods exist to fragment them before removal. Although holmium laser is frequently used in urological surgery, it is rarely used to achieve this aim. METHODS The holmium laser was passed along a fiber introduced via a flexible scope through the cystic duct at the time of laparoscopic cholecystectomy. This energy modality was used to fragment the stones to a size that allowed easy removal. RESULTS The authors have used this technique once so far and achieved complete clearance of the CBD with no mucosal damage. CONCLUSION Holmium laser provides an alternative and realistic treatment option for difficult CBD stones.
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Affiliation(s)
- Andrew Day
- Department of Surgery, Worthing and Southlands Hospitals NHS Trust, West Sussex, United Kingdom.
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Jakobs R, Pereira-Lima JC, Schuch AW, Pereira-Lima LF, Eickhoff A, Riemann JF. Endoscopic laser lithotripsy for complicated bile duct stones: is cholangioscopic guidance necessary? ARQUIVOS DE GASTROENTEROLOGIA 2008; 44:137-40. [PMID: 17962859 DOI: 10.1590/s0004-28032007000200010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Accepted: 05/04/2006] [Indexed: 12/31/2022]
Abstract
BACKGROUND Endoscopic papillotomy is successful in more than 95% of the cases of choledocholithiasis. For patients with difficult bile duct stones not responding to mechanical lithotripsy, different methods for stone fragmentation have been developed. AIM To compare the results of laser lithotripsy with a stone-tissue recognizing system, when guided by fluoroscopy only or by cholangioscopy. METHODS Between 1992 and 2002 we have treated 89 patients with difficult bile duct stones by endoscopic retrograde cholangiopancreatography and laser lithotripsy. Unsuccessful extracorporeal shock-wave lithotripsy and electrohydraulic were also performed before laser in 35% and 26% of the cases, respectively. RESULTS Laser was effective in 79.2% of 72 patients guided by cholangioscopy and in 82.4% of 17 cases steered by fluoroscopy. The median number of impulses in the latter was 4,335 and 1,800 with the former technique. Two parameters influenced the manner of laser guidance. In cases of stones situated above a stricture, cholangioscopic control was more effective (64.7% vs. 31.9%). When the stones were in the distal bile duct, fluoroscopic control was more successful. CONCLUSION In cases of difficult stones in the distal bile duct, laser lithotripsy under fluoroscopic control is very effective and easily performed. Cholangioscopic guidance should be recommended just in cases of intrahepatic stones or in patients with stones situated proximal to a bile duct stenosis. In these cases, cholangioscopy should be performed either endoscopically or percutaneously.
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Affiliation(s)
- Ralf Jakobs
- Departments of Internal Medicine C, Klinikum Ludwigshafen, Ludwigshafen, Germany
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Conigliaro R, Camellini L, Zuliani CG, Sassatelli R, Mortilla MG, Bertoni G, Formisano D, Bedogni G. Clearance of irretrievable bile duct and pancreatic duct stones by extracorporeal shockwave lithotripsy, using a transportable device: effectiveness and medium-term results. J Clin Gastroenterol 2006; 40:213-9. [PMID: 16633122 DOI: 10.1097/00004836-200603000-00008] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND GOALS Extracorporeal shockwave lithotripsy (ESWL) is an established treatment of irretrievable biliary and pancreatic stones, but the cost of the shockwave generators limits its widespread use. We revised data about the effectiveness of our treatment for refractory stones using a transportable shockwave generator. STUDY We retrospectively evaluated the short and medium-term outcomes of patients who underwent ESWL using a transportable electromagnetic shockwave generator between 1998 and 2003 at our unit, for the treatment of irretrievable bile duct or pancreatic duct stones. All patients received intravenous conscious sedation and antibiotic prophylaxis. RESULTS Complete stone clearance was achieved in 70/82 patients (85.4%), in 66 of the patients (94.2%) with 1 session of ESWL. Despite the insertion of a stent in the bile duct, 2 patients had moderate cholangitis, while they waited for the next ESWL session. We did not record any moderate-severe complication of ESWL, but 2 patients underwent surgery owing to perforation/bleeding during endoscopic removal of residual fragments. A symptomatic recurrence of stones was recorded in 10/69 (14.5%) patients, who had been previously cleared and whose follow-up data (median follow-up 29 mo; range 7 to 66) were available. CONCLUSIONS We obtained satisfactory stone clearance by using a transportable shockwave generator. Most patients required 1 session. Our experience confirmed the safety of the treatment, even though patients may experience cholangitis while awaiting definitive treatment. The use of a transportable ESWL generator may be a valuable option in centers, while ensuring a sufficient proficiency in biliary endoscopy.
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Affiliation(s)
- Rita Conigliaro
- Department of Surgery, Gastrointestinal Endoscopy Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
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Xu Z, Wang LX, Zhang NW, Hou CS, Ling XF, Xu Y, Zhou XS. Clinical application of plasma shock wave lithotripsy in treating impacted stones in the bile duct system. World J Gastroenterol 2006; 12:130-3. [PMID: 16440432 PMCID: PMC4077491 DOI: 10.3748/wjg.v12.i1.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To verify the safety and efficacy of plasma shock wave lithotripsy (PSWL) in fragmenting impacted stones in the bile duct system.
METHODS: From September 1988 to April 2005, 67 patients (26 men and 41 women) with impacted stones underwent various biliary operations with tube (or T-tube) drainage. Remnant and impacted stones in the bile duct system found by cholangiography after the operation were fragmented by PSWL and choledochofiberscopy. A total of 201 impacted stones were fragmented by PSWL setting the voltage at 2.5-3.5 kV, and the energy output at 2-3 J for each pulse of PSWL. Then the fragmented stones were extracted by choledochofiberscopy. The safety and efficacy of PSWL were observed during and after the procedure.
RESULTS: One hundred and ninety-nine of 201 impacted stones (99.0%) in the bile duct system were successfully fragmented using PSWL and extracted by choledochofiberscopy. The stone clearance rate for patients was 97% (65/67). Ten patients felt mild pain in the right upper quadrant of the abdomen, and could tolerate it well. Eleven patients had a small amount of bleeding from the mucosa of the bile duct. The bleeding was transient and stopped spontaneously within 2 min of normal saline irrigation. There were no significant complications during and after the procedure.
CONCLUSION: PSWL is a safe and effective method for fragmenting impacted stones in the bile duct system.
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Affiliation(s)
- Zhi Xu
- Department of Surgery, Third Hospital of Peking University, 49 North Garden Road, Haidian District, Beijing 100083, China.
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Fukuda Y, Tsuyuguchi T, Sakai Y, Tsuchiya S, Saisyo H. Diagnostic utility of peroral cholangioscopy for various bile-duct lesions. Gastrointest Endosc 2005; 62:374-82. [PMID: 16111955 DOI: 10.1016/j.gie.2005.04.032] [Citation(s) in RCA: 177] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Accepted: 04/15/2005] [Indexed: 12/20/2022]
Abstract
BACKGROUND We evaluated the utility of peroral cholangioscopy (POCS) for distinguishing malignant from benign biliary disease to cover low sensitivity of tissue sampling. METHODS From February 1992 to April 2004, all consecutive patients who underwent POCS to confirm the etiology of biliary disorders were included in this study. Brushing cytology or endobiliary forceps biopsy also was performed. We analyzed the diagnostic accuracy of tissue sampling with or without POCS diagnosis. RESULTS A total of 97 patients (66 men, 31 women; mean age 64.2 years) were included. The final diagnosis was confirmed by surgical resection in 44, clinical follow-up in 52, and cytologic study of ascitic fluid in one. On the basis of ERCP findings, there were 76 strictures and 21 filling defects. Forceps biopsy was performed in 25 patients, and brush cytology was performed in 68 patients. In the remaining 4 patients (4 filling defects, which were identified as stones by POCS), tissue samplings were not carried out. ERCP/tissue sampling correctly identified 22 of 38 malignant strictures and all 35 benign lesions except in 3 patients with inadequate samples (accuracy, 78.0%; sensitivity, 57.9%; specificity, 100%). The addition of POCS correctly identified all 38 malignant strictures and 33 of 38 benign lesions (accuracy, 93.4%; sensitivity, 100%; specificity, 86.8%). For the 21 filling defects observed by ERCP, POCS correctly diagnosed all 8 malignant diseases and 13 benign lesions. CONCLUSIONS The addition of POCS to tissue sampling improves the diagnostic ability and covers for insufficient sensitivity. POCS is especially useful for diagnosing a filling defect.
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Affiliation(s)
- Yoshihiro Fukuda
- Department of Medicine and Clinical Oncology Graduate School of Medicine Chiba University, Japan
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18
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Itoi T, Kurihara T, Tsuchiya T. A CASE WITH GALLBLADDER CANCER DIAGNOSED BY PERORAL CHOLECYSTOSCOPY (POCCS) AFTER LITHOTRIPSY IN THE COMMON BILE DUCT STONES. Dig Endosc 2005. [DOI: 10.1111/j.1443-1661.2005.00543.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Chang WH, Chu CH, Wang TE, Chen MJ, Lin CC. Outcome of simple use of mechanical lithotripsy of difficult common bile duct stones. World J Gastroenterol 2005. [PMID: 15641153 DOI: 10.3748/wjg.v11.i3.593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM The usual bile duct stone may be removed by means of Dormia basket or balloon catheter, and results are quite good. However, the degree of difficulty is increased when stones are larger. Studies on the subject reported many cases where mechanical lithotripsy is combined with a second technique, e.g. electrohydraulic lithotripsy (EHL), where stones are crushed using baby-mother scope electric shock. The extracorporeal shock-wave lithotripsy (ESWL) or laser lithotripsy also yields an excellent success rate of greater than 90%. However, the equipment for these techniques are very expensive; hence we opted for the simple mechanical lithotripsy and evaluated its performance. METHODS During the period from August 1996 to December 2002, Mackay Memorial Hospital treated 304 patients suffering from difficult bile duct stones (stone >1.5 cm or stones that could not be removed by the ordinary Dormia basket or balloon catheter). These patients underwent endoscopic papillotomy (EPT) procedure, and stones were removed by means of the Olympus BML-4Q lithotripsy. A follow-up was conducted on the post-treatment conditions and complications of the patients. RESULTS Out of the 304 patients, bile duct stones were successfully removed from 272 patients, a success rate of about 90%. The procedure failed in 32 patients, for whom surgery was needed. Out of the 272 successfully treated patients, 8 developed cholangitis, 21 developed pancreatitis, and 10 patients had delayed bleeding, and no patient died. Among these 272 successful removal cases, successful bile duct stone removal was achieved after the first lithotripsy in 211 patients, whereas 61 patients underwent multiple sessions of lithotripsy. As for the 61 patients that underwent multiple sessions of mechanical lithotripsy, 6 (9.8%) had post-procedure cholangitis, 12 (19.6%) had pancreatitis, and 9 patients (14.7%) had delayed bleeding. Compared with the 211 patients undergoing a single session of mechanical lithotripsy, 3 (1.4%) had cholangitis, 1 (0.4%) had delayed bleeding, and 7 patients (3.3%) had pancreatitis. Statistical deviation was present in post-procedure cholangitis, delayed bleeding, and pancreatitis of both groups. CONCLUSION Mechanical bile stone lithotripsy on difficult bile duct stones could produce around 90% successful rate. Moreover, complications are minimal. This finding further confirms the significance of mechanical lithotripsy in the treatment of patients with difficult bile duct stones.
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Affiliation(s)
- Wen-Hsiung Chang
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
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20
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Chang WH, Chu CH, Wang TE, Chen MJ, Lin CC. Outcome of simple use of mechanical lithotripsy of difficult common bile duct stones. World J Gastroenterol 2005; 11:593-596. [PMID: 15641153 PMCID: PMC4250818 DOI: 10.3748/wjg.v11.i4.593] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2004] [Revised: 05/12/2004] [Accepted: 06/18/2004] [Indexed: 02/06/2023] Open
Abstract
AIM The usual bile duct stone may be removed by means of Dormia basket or balloon catheter, and results are quite good. However, the degree of difficulty is increased when stones are larger. Studies on the subject reported many cases where mechanical lithotripsy is combined with a second technique, e.g. electrohydraulic lithotripsy (EHL), where stones are crushed using baby-mother scope electric shock. The extracorporeal shock-wave lithotripsy (ESWL) or laser lithotripsy also yields an excellent success rate of greater than 90%. However, the equipment for these techniques are very expensive; hence we opted for the simple mechanical lithotripsy and evaluated its performance. METHODS During the period from August 1996 to December 2002, Mackay Memorial Hospital treated 304 patients suffering from difficult bile duct stones (stone >1.5 cm or stones that could not be removed by the ordinary Dormia basket or balloon catheter). These patients underwent endoscopic papillotomy (EPT) procedure, and stones were removed by means of the Olympus BML-4Q lithotripsy. A follow-up was conducted on the post-treatment conditions and complications of the patients. RESULTS Out of the 304 patients, bile duct stones were successfully removed from 272 patients, a success rate of about 90%. The procedure failed in 32 patients, for whom surgery was needed. Out of the 272 successfully treated patients, 8 developed cholangitis, 21 developed pancreatitis, and 10 patients had delayed bleeding, and no patient died. Among these 272 successful removal cases, successful bile duct stone removal was achieved after the first lithotripsy in 211 patients, whereas 61 patients underwent multiple sessions of lithotripsy. As for the 61 patients that underwent multiple sessions of mechanical lithotripsy, 6 (9.8%) had post-procedure cholangitis, 12 (19.6%) had pancreatitis, and 9 patients (14.7%) had delayed bleeding. Compared with the 211 patients undergoing a single session of mechanical lithotripsy, 3 (1.4%) had cholangitis, 1 (0.4%) had delayed bleeding, and 7 patients (3.3%) had pancreatitis. Statistical deviation was present in post-procedure cholangitis, delayed bleeding, and pancreatitis of both groups. CONCLUSION Mechanical bile stone lithotripsy on difficult bile duct stones could produce around 90% successful rate. Moreover, complications are minimal. This finding further confirms the significance of mechanical lithotripsy in the treatment of patients with difficult bile duct stones.
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Affiliation(s)
- Wen-Hsiung Chang
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
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21
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Moon JH, Cha SW, Ryu CB, Kim YS, Hong SJ, Cheon YK, Cho YD, Kim YS, Lee JS, Lee MS, Shim CS, Kim BS. Endoscopic treatment of retained bile-duct stones by using a balloon catheter for electrohydraulic lithotripsy without cholangioscopy. Gastrointest Endosc 2004; 60:562-6. [PMID: 15472679 DOI: 10.1016/s0016-5107(04)02012-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Electrohydraulic lithotripsy is a highly effective method for fragmenting biliary stones, but direct visual control is required. The efficacy and the safety of electrohydraulic lithotripsy without cholangioscopy by using a balloon catheter were evaluated in patients with bile-duct stones that could not be extracted by using standard techniques. METHODS Nineteen patients with extrahepatic bile-duct stones that could not be extracted by using conventional endoscopic methods, e.g., mechanical lithotripsy, were selected to undergo electrohydraulic lithotripsy without peroral cholangioscopy. An electrohydraulic lithotripsy probe with a 3.0 F radio-opaque tip was inserted through a balloon catheter. Electrohydraulic lithotripsy was performed under fluoroscopy until the fragmented stone could be captured in a large basket for mechanical lithotripsy. Endoscopic removal of the fragments was attempted during the electrohydraulic lithotripsy session. RESULTS Stones were successfully fragmented in 17 of 19 patients. In 16 patients (84.2%), the bile duct was cleared of all stones. A mean of 1.8 endoscopic sessions was required for complete removal. Additional mechanical lithotripsy was performed in 9 (56.2%) of the 16 patients. Minor complications were noted in 4 patients (2 hemobilia, 1 pancreatitis, 1 cholangitis). There was no 30-day mortality. CONCLUSIONS For a selected group of patients with bile-duct stones not extractable by using standard techniques, fluoroscopically controlled electrohydraulic lithotripsy with a balloon catheter seems to be an effective method of fragmentation.
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Affiliation(s)
- Jong Ho Moon
- Digestie Disease Center, Institute for Digestive Research, Soon Chun Hyang University College of Medicine, Seoul, Korea
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22
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Xu Z, Wang L, Zhang N, Deng S, Xu Y, Zhou X. Clinical applications of plasma shock wave lithotripsy in treating postoperative remnant stones impacted in the extra- and intrahepatic bile ducts. Surg Endosc 2002; 16:646-9. [PMID: 11972206 DOI: 10.1007/s00464-001-8146-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2001] [Accepted: 08/16/2001] [Indexed: 12/17/2022]
Abstract
BACKGROUND Choledochofiberscopy with basket extraction has been used widely to treat postoperative remnant stones in the bile duct system. However, it remains difficult to extract stones impacted in the bile duct system or stones too large to pass through the T-tube fistula. This report describes the efficacy and safety of plasma shock wave lithotripsy (PSWL) in fragmenting and eliminating such remnant stones from the bile duct. METHODS In 52 patients, 117 remnant stones were fragmented with PSWL and subsequently extracted with choledochofiberscopy. The efficacy and safety of PSWL were observed during and after the procedure. RESULTS After 116 of 117 remnant stones (99.1%) impacted in the extra- and intrahepatic bile ducts were fragmented successfulIy with PSWL, they were extracted with choledochofiberscopy. There were no significant complications during and after the procedure. CONCLUSION It appears that PSWL is an effective and safe method for fragmenting remnant stones impacted in the bile duct system and stones too large to pass through the T-tube fistula.
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Affiliation(s)
- Z Xu
- Department of Surgery, Third Teaching Hospital of Peking University, 49 North Garden Road, Haidian District, Beijing, 100083, Peoples' Republic of China. ;
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23
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Affiliation(s)
- Jost Langhorst
- Department of Medicine, Evangelisches Krankenhaus Düsseldorf, Academic Teaching Hospital of the University of Düsseldorf, Düsseldorf, Germany
| | - Horst Neuhaus
- Department of Medicine, Evangelisches Krankenhaus Düsseldorf, Academic Teaching Hospital of the University of Düsseldorf, Düsseldorf, Germany
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24
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Clinical applications of plasma shock wave lithotripsy in treating postoperative remnant stones impacted in the extra- and intrahepatic bile ducts. Surg Endosc 2001. [PMID: 11972206 DOI: 10.1007/s00464-001-8164-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Choledochofiberscopy with basket extraction has been used widely to treat postoperative remnant stones in the bile duct system. However, it remains difficult to extract stones impacted in the bile duct system or stones too large to pass through the T-tube fistula. This report describes the efficacy and safety of plasma shock wave lithotripsy (PSWL) in fragmenting and eliminating such remnant stones from the bile duct. METHODS In 52 patients, 117 remnant stones were fragmented with PSWL and subsequently extracted with choledochofiberscopy. The efficacy and safety of PSWL were observed during and after the procedure. RESULTS After 116 of 117 remnant stones (99.1%) impacted in the extra- and intrahepatic bile ducts were fragmented successfulIy with PSWL, they were extracted with choledochofiberscopy. There were no significant complications during and after the procedure. CONCLUSION It appears that PSWL is an effective and safe method for fragmenting remnant stones impacted in the bile duct system and stones too large to pass through the T-tube fistula.
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25
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Teichman JM, Schwesinger WH, Lackner J, Cossman RM. Holmium: YAG laser lithotripsy for gallstones. A preliminary report. Surg Endosc 2001; 15:1034-7. [PMID: 11605114 DOI: 10.1007/s004640080149] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2001] [Accepted: 03/05/2001] [Indexed: 12/31/2022]
Abstract
BACKGROUND Most retained gallstones can be extracted at the time of operative exploration or endoscopic retrograde cholangiopancreatography (ERCP). Infrequently, impaction or associated anatomic abnormalities may prevent their clearance. We assessed the efficacy of the holmium:YAG laser in managing retained biliary calculi that had proven refractory to the usual methods of extraction. METHODS Two patients with calculi impacted in the intrapancreatic common bile duct and one patient with residual stones in a nonfunctional gallbladder were treated with holmium:YAG laser lithotripsy. Two of these patients were treated under conscious sedation, and one received a general endotracheal anesthetic. Laser energy was delivered by a 272-mm optical fiber inserted through a 7-Fr fiberoptic endoscope. The ablative effects were monitored continuously via videoscopic. RESULTS All of the stones were cleared successfully in a single therapeutic setting. In one patient, fragments of the impacted intraductal stone were extracted with an endoscopic wire basket. In the other two patients, stone debris was completely cleared with saline irrigation. No complications developed, and all patients remained free of recurrence during a 6-month follow-up period. CONCLUSIONS The holmium:YAG laser is a multidisciplinary instrument that is safe and effective in the fragmentation of both urinary and biliary calculi. Because it can be delivered through a small-caliber fiberoptic endoscope, it should be particularly useful to laparoscopic surgeons who manage complicated biliary tract disease.
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Affiliation(s)
- J M Teichman
- Department of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284-7845, USA.
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26
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Sackmann M, Holl J, Sauter GH, Pauletzki J, von Ritter C, Paumgartner G. Extracorporeal shock wave lithotripsy for clearance of bile duct stones resistant to endoscopic extraction. Gastrointest Endosc 2001; 53:27-32. [PMID: 11154485 DOI: 10.1067/mge.2001.111042] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic extraction of bile duct stones after sphincterotomy has a success rate of up to 95%. Failures occur in patients with extremely large stones, intrahepatic stones, and bile duct strictures. This study examined the efficacy and the safety of extracorporeal shock-wave lithotripsy in a large cohort of patients in whom routine endoscopic measures including mechanical lithotripsy had failed to extract bile duct stones. METHODS Out of 1587 consecutive patients, endoscopic stone extraction including mechanical lithotripsy was unsuccessful in 313 (20%). These 313 patients (64% women, median age, 73 years) underwent high-energy extracorporeal shock-wave lithotripsy. Stone targeting was performed fluoroscopically (99%) or by ultrasonography (1%). RESULTS Complete clearance of bile duct calculi was achieved in 281 (90%) patients. In 80% of the patients, the fragments were extracted endoscopically after shock-wave therapy; spontaneous passage was observed in 10%. For patients with complete clearance compared with those without there were no differences with regard to size or number of the stones, intrahepatic or extrahepatic stone location, presence or absence of bile duct strictures, or type of lithotripter. Cholangitis (n = 4) and acute cholecystitis (n = 1) were the rare adverse effects. CONCLUSIONS In patients with bile duct calculi that are difficult to extract endoscopically, high-energy extracorporeal shock-wave lithotripsy is a safe and effective therapy regardless of stone size, stone location, or the presence of bile duct stricture.
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Affiliation(s)
- M Sackmann
- Department of Medicine II, Klinikum Grosshadern, Ludwig-Maximilian's University, Munich, Germany
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27
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Rosin D, Brasesco O, Rosenthal RJ. A review of technical and clinical aspects of biliary laser lithotripsy. JOURNAL OF CLINICAL LASER MEDICINE & SURGERY 2000; 18:301-7. [PMID: 11572224 DOI: 10.1089/clm.2000.18.301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This paper reviews the current use of laser techniques for the treatment of biliary stones. BACKGROUND DATA Biliary stones may pose a special problem when access to them is limited, when previous attempts of removal have failed, or when a less invasive option than surgery is needed. The availability of various laser sources and the adaptation of the technology for safe use in the biliary system make the use of laser energy for stone fragmentation possible. METHODS Current literature is reviewed concerning the use of laser for biliary lithotripsy, including experimental data and experience with human series. Technology, indications, alternatives, and cumulative world experience are discussed. CONCLUSIONS Recent technical advances have made the use of laser energy for fragmentation of biliary calculi possible. It is a valid option for treatment of "difficult" stones, when other methods have failed or as a primary treatment in certain situations. The technical complexity and the high cost limit its use for specialized centers.
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Affiliation(s)
- D Rosin
- Department of Surgery, Cleveland Clinic Florida, Ft Lauderdale 33309, USA
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28
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Monga M, Gabal-Shehab LL, Kamarei M, D'Agostino H. Holmium laser lithotripsy of a complicated biliary calculus. J Endourol 1999; 13:505-6. [PMID: 10569524 DOI: 10.1089/end.1999.13.505] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
More than 500,000 cholecystectomies are performed annually. Extracorporeal shockwave lithotripsy and endoscopic laser lithotripsy have been used for the management of common bile duct calculi, which complicate 10% of cases. We report the first successful clinical application of the Ho:YAG laser to a complex biliary calculus case.
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Affiliation(s)
- M Monga
- Division of Urology, University of California at San Diego, 92103-8897, USA.
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29
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Sorbi D, Van Os EC, Aberger FJ, Derfus GA, Erickson R, Meier P, Nelson D, Nelson P, Shaw M, Gostout CJ. Clinical application of a new disposable lithotripter: a prospective multicenter study. Gastrointest Endosc 1999; 49:210-3. [PMID: 9925700 DOI: 10.1016/s0016-5107(99)70488-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Mechanical lithotripsy has become a well-accepted method of bile duct stone fragmentation and removal. The Olympus lithotripter (Olympus American, Melville, NY) is the standard reusable lithotripter at the institutions that participated in this study. A disposable device with a preassembled pistol grip may perform equally well and facilitate operation. METHODS Twenty patients with bile duct stones were evaluated as part of a multicenter prospective study. Data were obtained regarding stone size and number, bile duct diameter, and configuration, ease of cannulation, basket function, stone capture and crushing success, and complications. RESULTS The maximum stone size averaged 16.5 +/- 1.2 mm (range 10 to 30 mm). Sixteen patients had multiple stones (median 5, range 2 to 12). The mean bile duct diameter was 20.5 +/- 1.5 mm (range 12 to 38 mm). Cannulation was successful in all within 5 attempts. Basket deployment failed in 1 patient because of stone size and the basket was misshapen in 14. Bile duct clearance was complete in 16 subjects (80%), incomplete in 2 patients, and failed in 2 patients. Abnormal duct configuration (sigmoid, stricture) was noted in 2 of 4 patients with failed capture and 7 of 16 patients with successful clearance. No statistically significant difference was observed between the bile duct diameter, maximum stone size, number of stones, and successful clearance. CONCLUSION The disposable lithotripter is easy to use and, compared with the published results for the reusable lithotripter, performs almost as well.
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Affiliation(s)
- D Sorbi
- Mayo Clinic, Rochester; Gundersen Lutheran, LaCrosse, Wisconsin; Midelfort Clinic, Eau Claire, Wisconsin, USA
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30
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Cheung MT. Postoperative choledochoscopic removal of intrahepatic stones via a T tube tract. Br J Surg 1997. [PMID: 9313698 DOI: 10.1002/bjs.1800840908] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The management of primary intrahepatic stones is extremely difficult. During operation it is often difficult to remove all the stones. The postoperative T tube tract provides an invaluable access to the intrahepatic system. METHODS This paper reports a retrospective review of postoperative choledochoscopic removal of intrahepatic stones in a series of 44 patients. Special emphasis is placed on the result of the procedure and on the long-term outcome of patients. RESULTS Overall, the procedure was successful in 22 of the 44 patients. Presence of strictures was associated significantly with failure rate (P = 0.002). There were complications in five patients; most subsided with conservative management. However, there was one procedure-related death in the series. Some 28 patients were followed for 16-115 months. The long-term outcome was significantly related to the success rate of choledochoscopic stone removal (P = 0.03). CONCLUSION All intrahepatic stones should be removed. T tube choledochoscopy is the preferred method for treating retained intrahepatic stones. This should be supplemented with other modalities of treatment, such as endoscopic and radiological approaches, especially in patients with strictures.
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Affiliation(s)
- M T Cheung
- Department of Surgery, Queen Elizabeth Hospital, Kowloon, Hong Kong
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Jakobs R, Adamek HE, Maier M, Krömer M, Benz C, Martin WR, Riemann JF. Fluoroscopically guided laser lithotripsy versus extracorporeal shock wave lithotripsy for retained bile duct stones: a prospective randomised study. Gut 1997; 40:678-82. [PMID: 9203950 PMCID: PMC1027174 DOI: 10.1136/gut.40.5.678] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS To compare extracorporeal shock wave lithotripsy (ESWL) and laser induced shock wave lithotripsy (LISL) of retained bile duct stones to stone free rate, number of therapeutic sessions, and costs. PATIENTS Thirty four patients were randomly assigned to either ESWL or LISL therapy. The main reasons for failure of standard endoscopy were due to stone impaction (n = 12), biliary stricture (n = 8), or large stone diameter (n = 14). METHODS An extracorporeal piezoelectic lithotripter with ultrasonic guidance and a rhodamine 6G laser with an integrated stone tissue detection system were used. LISL was performed exclusively under radiological control. RESULTS Using the initial methods complete stone fragmentation was achieved in nine of 17 patients (52.4%) of the ESWL group and in 14 of 17 patients (82.4%) in the LISL group, or combined with additional fragmentation techniques 31 of the 34 patients (91.2%) were stone free at the end of treatment. In comparison LISL tended to be more efficient in clearing the bile ducts (p = 0.07, NS). Significantly less fragmentation sessions (1.29 v 2.82; p = 0.0001) and less additional endoscopic sessions (0.65 v 1.6; p = 0.002) were necessary in the LISL group. There were no major complications in either procedure. CONCLUSIONS Compared with ESWL, fluoroscopically guided LISL achieves stone disintegration more rapidly and with significantly less treatment sessions, which leads to a significant reduction in cost.
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Affiliation(s)
- R Jakobs
- Department of Medicine C, Klinikum Ludwigahafen, Germany
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SAISHO H. Intracorporeal Shock Wave Lithotripsy (ISWL) in Bile Ducts under Peroral Endoscopy: Progress and Current Status. Dig Endosc 1995. [DOI: 10.1111/j.1443-1661.1995.tb00120.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Hiromitsu SAISHO
- The First Department of Internal Medicine, Chiba University School of Medicine, Chiba, Japan
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