Format

Send to

Choose Destination
Endoscopy. 2019 Jun 27. doi: 10.1055/a-0942-9336. [Epub ahead of print]

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.

Author information

1
Baldota Institute of Digestive Sciences, Global Hospital, Mumbai, Maharashtra, India.
2
Chulalongkorn University, Bangkok, Thailand.
3
Prince of Wales Hospital, Shatin, Hong Kong.
4
King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
5
Civil Hospital, Karachi, Karachi, Pakistan.
6
Tokyo Medical University, Tokyo, Japan.
7
Changi General Hospital, Singapore, Singapore.
8
Netcare Unitas Hospital, Pretoria, South Africa.
9
Asan Medical Center, Seoul, Republic of Korea.
10
Asian Institute of Gastroenterology, Hyderabad, India.
11
University of Queensland Medical School, Brisbane, Queensland, Australia.
12
Samsung Medical Center, Seoul, Republic of Korea.
13
Apollo Gleneagles Hospital, Kolkata, India.
14
Medanta the Medicity, Gurgaon, India.
15
Royal Adelaide Hospital, Adelaide, South Australia, Australia.
16
Postgraduate Institute of Medical Education and Research, Chandigarh, India.
17
Boston Scientific Corporation, Marlborough, Massachusetts, USA.
18
SoonChunHyang University Hospital, Bucheon, Republic of Korea.

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.

PMID:
31250408
DOI:
10.1055/a-0942-9336

Conflict of interest statement

Dr. Anthony Teoh is a paid consultant for Boston Scientific Corporation, Taewoong Medical Co., Ltd., Cook Medical, and Micro-Tech Europe. Dr. Benedict Devereaux is a member of the speakers’ bureau of Boston Scientific Corporation. Joyce Peetermans, PhD, Pooja G. Goswamy, and Matthew Rousseau are employees of Boston Scientific Corporation, the sponsor of this registry. Dr. Takao Itoi is a consultant to Boston Scientific Corporation, Olympus Corporation, Fujifilm Corporation, and Gadelius Medical. All other authors disclose no financial or other relationships related to the work described in this manuscript.

Supplemental Content

Full text links

Icon for Georg Thieme Verlag Stuttgart, New York
Loading ...
Support Center