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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

Authors
Maydeo, Amit P.Rerknimitr, RungsunLau, James Y.Aljebreen, AbdulrahmanNiaz, Saad K.Itoi, TakaoAng, Tiing LeongReichenberger, JorgSeo, Dong WanRamchandani, Mohan K.Devereaux, Benedict M.Lee, Jong KyunGoenka, Mahesh K.Sud, RandhirNam Q NguyenKochhar, RakeshPeetermans, JoyceGoswamy, Pooja G.Rousseau, MatthewBhandari, Surya PrakashAngsuwatcharakon, PhonthepTang, Raymond S. Y.Teoh, Anthony Y. B.Almadi, MajidLee, Yun NahMoon, Jong Ho
Issue Date
Oct-2019
Publisher
Georg Thieme Verlag
Keywords
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
Citation
Endoscopy, v.51, no.10, pp 922 - 929
Pages
8
Journal Title
Endoscopy
Volume
51
Number
10
Start Page
922
End Page
929
URI
https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/4178
DOI
10.1055/a-0942-9336
ISSN
0013-726X
1438-8812
Abstract
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 >= 15 mm, 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 (80%), while 32/156 patients (21%) were referred directly to POCS-guided therapy based on preprocedural assessment of the difficulty of stone clearance. In 101/156 patients (65%), there were impacted stones. POCS-guided stone clearance was achieved in a single POCS procedure in 125/156 patients (80%, 95% confidence interval [CI] 73%-86%), and was significantly more likely for stones <= 30 mm compared with >30 mm (odds ratio 7.9, 95%CI 2.4-26.2; P=0.002). Serious adverse events occurred in 3/156 patients (1.9%, 95%CI 0.4%-5.5%), and included pancreatitis, perforation due to laser lithotripsy, and cholangitis (n=1 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.
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