Utility of Direct Peroral Cholangioscopy Using a Multibending Ultraslim Endoscope for Difficult Common Bile Duct Stones

• Published in: Gut and liver Vol. 16; no. 4; pp. 599 - 605
• Main Authors: Lee, Won Myung, Moon, Jong Ho, Lee, Yun Nah, Shin, Il Sang, Lee, Tae Hoon, Yang, Jae Kook, Cha, Sang-Woo, Cho, Young Deok, Park, Sang-Heum
• Format: Journal Article
• Language: English
• Published: Korea (South) Editorial Office of Gut and Liver 01-07-2022; Gastroenterology Council for Gut and Liver; 거트앤리버 소화기연관학회협의회
• Subjects: common bile duct; endoscopes; gallstones; Original; peroral cholangioscopy; 내과학; Gallstones; Common bile duct; Endoscopes; Peroral cholangioscopy
• ISSN: 1976-2283; 2005-1212
• DOI: 10.5009/gnl210355

Treatment options for difficult bile duct stones are limited. Direct peroral cholangioscopy (POC)-guided lithotripsy may be an option. A newly developed multibending (MB) ultraslim endoscope has several structural features optimized for direct POC. We evaluated the utility of direct POC using an MB ultraslim endoscope for lithotripsy in patients with difficult bile duct stones.
Twenty patients with difficult bile duct stones, in whom stone removal using conventional endoscopic methods, including mechanical lithotripsy, had failed were enrolled from March 2018 to August 2019. Direct POC-guided lithotripsy was performed by electrohydraulic lithotripsy or laser lithotripsy. The primary outcome was complete ductal clearance, defined as the retrieval of all bile duct stones after lithotripsy confirmed by balloon-occluded cholangiography and/or direct POC.
The technical success rate of direct POC was 100% (20/20), and the free-hand insertion rate was 95% (19/20). Direct POC-guided lithotripsy, attempted by electrohydraulic lithotripsy in nine patients (45%) and laser lithotripsy in 11 patients (55%), was successful in 95% (19/20) of the patients. Complete ductal clearance after direct POC-guided lithotripsy was achieved in 95% (19/20) of patients. Patients required a median of 2 (range, 1-3) endoscopic retrograde cholangiopancreatography sessions for complete stone removal. Adverse event was observed in one patient (5%) with hemobilia and was treated conservatively.
Direct POC using an MB ultraslim endoscope was safe and effective for lithotripsy in patients with difficult bile duct stones.