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Peroral Cholangioscopy-Assisted Electrohydraulic Lithotripsy for Complex Biliary Stones: Efficacy, Safety, and Procedural Insights
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Ichitaro Horiuchi1,
Yasuhiro Kuraishi1,
Takeji Umemura1 |
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1Department of Gastroenterology, Shinshu University Hospital |
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| Background: Management of complex biliary stones has often required surgical intervention. Recent advances in endoscopic techniques have made surgery unnecessary in most cases. We manage complex biliary stones with peroral cholangioscopy (POCS) and electrohydraulic lithotripsy (EHL). This study evaluates the efficacy and safety of POCS for stone removal, offering concise procedural insights and techniques through video demonstrations. Methods: This retrospective analysis included 30 patients 36 POCS procedures for the complex stone removal from June 2016 to December 2023. Indications for POCS included failure of conventional ERCP approach. EHL was used for lithotripsy under cholangioscopy. Primary outcome was the complete clearance rate, with a secondary outcome of adverse events. Results: The cohort comprised 20 males with a median age of 72 years. Altered anatomy included 8 cases. The complete clearance rate was 90% (27/30 cases), with specific success rates of 93% (14/15) in common bile ducts, 85% (11/13) in intrahepatic ducts, and 100% (2/2) in cystic ducts. Adverse events occurred in 7 of 36 procedures, including 5 cholangitis, 1 bleeding, and 1 bile duct perforation, all of which were effectively managed conservatively. Conclusions: Our findings demonstrate a high success rate in the endoscopic removal of complex biliary stones using POCS-assisted EHL, significantly reducing the need for surgical interventions. The techniques and strategies developed through this study contribute valuable procedural insights for the management of difficult biliary stones. |
Index Term 1: biliary stone
Index Term 2: cholangioscopy
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