Tandem Standard-Size and (“Diagnostic”) Ultra-Slim Cholangioscopy to Guide and Validate Completeness of Mechanical Lithotripsy

• Published in: GE Portuguese journal of gastroenterology Vol. 29; no. 4; pp. 293 - 295
• Main Author: Zimmer, Vincent
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01-07-2022; Karger Publishers
• Subjects: Bile ducts; cholangioscopy; cholecystectomy; complex bile duct stone disease; Conflicts of interest; Disease; endoscopic retrograde cholangiopancreatography; Endoscopic Snapshot; Endoscopy; Lithotripsy; Medical diagnosis; Cholecystectomy; Complex bile duct stone disease; Endoscopic retrograde cholangiopancreatography; Cholangioscopy; Endoscopy; Lithotripsy
• ISSN: 2341-4545; 2387-1954
• DOI: 10.1159/000516140

Of note, given the known lack of sensitivity to exclude remnant stone disease on cholangiography in the presence of diffuse bile duct dilation, cholangioscopic confirmation of freedom from stones might be implemented on a low-threshold basis; a recent small-scale study indicated detection of residual stones in > 20% of patients [1]. See PDF.] a Initial cholangiography indicating diffuse bile duct dilation with extensive stone burden. b Direct cholangioscopy (DC), using a standard-size upper endoscope with a 2.8-mm working channel sufficient to accommodate conventional ERCP devices, demonstrating a scarred stricture with a large residual stone above. c Successful cholangioscopy-guided capture using a rotable Dormia basket with high-expansion forces (twist’n’CATCH®, Medwork, Höchstadt/Aisch, Germany; d) as confirmed by fluoroscopy. e Uncomplicated mechanical lithotripsy (ML) above the stricture, with bile duct clearance by subsequent flushing out and/or extraction of ML fragments. f Freedom from residual bile duct stone disease finally confirmed by repeat “diagnostic” DC, using an ultra-slim upper endoscope able to pass the benign stricture. Tandem approaches in DC, relying on standard-size (a large-capacity working channel able to accept standard ERCP equipment) followed by (“diagnostic”) ultra-slim scope technology, are rarely considered in clinical practice [2]. Conflict of Interest Statement The authors have no conflicts of interest to declare.