Efficacy and Safety of Digital Single-Operator Cholangioscopy for Difficult Biliary Stones
- Authors
- Gutierrez, Olaya I. Brewer; Bekkali, Noor L. H.; Raijman, Isaac; Sturgess, Richard; Sejpal, Divyesh V.; Aridi, Hanaa D.; Sherman, Stuart; Shah, Raj J.; Kwon, Richard S.; Buxbaum, James L.; Zulli, Claudio; Wassef, Wahid; Adler, Douglas G.; Kushnir, Vladimir; Wang, Andrew Y.; Krishnan, Kumar; Kaul, Vivek; Tzimas, Demetrios; DiMaio, Christopher J.; Ho, Sammy; Petersen, Bret; Moon, Jong Ho; Elmunzer, B. Joseph; Webster, George J. M.; Chen, Yen-I.; Dwyer, Laura K.; Inamdar, Summant; Patrick, Vanessa B.; Attwell, Augustin; Hosmer, Amy; Ko, Christopher; Maurano, Attilio; Sarkar, Avik; Taylor, Linda J.; Gregory, Martin H.; Strand, Daniel S.; Raza, Ali; Kothari, Shivangi; Harris, Jessica P.; Kumta, Nikhil A.; Manvar, Amar; Topazian, Mark D.; Lee, Yun Nah; Spiceland, Clayton M.; Trindade, Arvind J.; Bukhari, Majidah A.; Sanaei, Omid; Ngamruengphong, Saowanee; Khashab, Mouen A.
- Issue Date
- Jun-2018
- Publisher
- W. B. Saunders Co., Ltd.
- Keywords
- Biliary Tract; Blockage; Choledocholithiasis; Gallstone
- Citation
- Clinical Gastroenterology and Hepatology, v.16, no.6, pp 918 - +
- Journal Title
- Clinical Gastroenterology and Hepatology
- Volume
- 16
- Number
- 6
- Start Page
- 918
- End Page
- +
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/5956
- DOI
- 10.1016/j.cgh.2017.10.017
- ISSN
- 1542-3565
1542-7714
- Abstract
- BACKGROUND & AIMS: It is not clear whether digital single-operator cholangioscopy (D-SOC) with electrohydraulic and laser lithotripsy is effective in removal of difficult biliary stones. We investigated the safety and efficacy of D-SOC with electrohydraulic and laser lithotripsy in an international, multicenter study of patients with difficult biliary stones. METHODS: We performed a retrospective analysis of 407 patients (60.4% female; mean age, 64.2 years) who underwent D-SOC for difficult biliary stones at 22 tertiary centers in the United States, United Kingdom, or Korea from February 2015 through December 2016; 306 patients underwent electrohydraulic lithotripsy and 101 (24.8%) underwent laser lithotripsy. Univariate and multivariable analyses were performed to identify factors associated with technical failure and the need for more than 1 D-SOC electrohydraulic or laser lithotripsy session to clear the bile duct. RESULTS: The mean procedure time was longer in the electrohydraulic lithotripsy group ( 73.9 minutes) than in the laser lithotripsy group (49.9 minutes; P < .001). Ducts were completely cleared (technical success) in 97.3% of patients (96.7% of patients with electrohydraulic lithotripsy vs 99% patients with laser lithotripsy; P = .31). Ducts were cleared in a single session in 77.4% of patients (74.5% by electrohydraulic lithotripsy and 86.1% by laser lithotripsy; P = .20). Electrohydraulic or laser lithotripsy failed in 11 patients (2.7%); 8 patients were treated by surgery. Adverse events occurred in 3.7% patients and the stone was incompletely removed from 6.6% of patients. On multivariable analysis, difficult anatomy or cannulation (duodenal diverticula or altered anatomy) correlated with technical failure (odds ratio, 5.18; 95% confidence interval, 1.26-21.2; P = .02). Procedure time increased odds of more than 1 session of D-SOC electrohydraulic or laser lithotripsy (odds ratio, 1.02; 95% confidence interval, 1.01-1.03; P < .001). CONCLUSIONS: In a multicenter, international, retrospective analysis, we found D-SOC with electrohydraulic or laser lithotripsy to be effective and safe in more than 95% of patients with difficult biliary stones. Fewer than 5% of patients require additional treatment with surgery and/or extracorporeal shockwave lithotripsy to clear the duct.
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