Endoscopy 2019; 51(10): 922-929
DOI: 10.1055/a-0942-9336
Original article
© Georg Thieme Verlag KG Stuttgart · New York

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

Authors

  • Amit P. Maydeo

     1   Baldota Institute of Digestive Sciences, Global Hospital, Mumbai, Maharashtra, India
  • Rungsun Rerknimitr

     2   Chulalongkorn University, Bangkok, Thailand
  • James Y. Lau

     3   Prince of Wales Hospital, Shatin, Hong Kong
  • Abdulrahman Aljebreen

     4   King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
  • Saad K. Niaz

     5   Civil Hospital, Karachi, Karachi, Pakistan
  • Takao Itoi

     6   Tokyo Medical University, Tokyo, Japan
  • Tiing Leong Ang

     7   Changi General Hospital, Singapore, Singapore
  • Jörg Reichenberger

     8   Netcare Unitas Hospital, Pretoria, South Africa
  • Dong Wan Seo

     9   Asan Medical Center, Seoul, Republic of Korea
  • Mohan K. Ramchandani

    10   Asian Institute of Gastroenterology, Hyderabad, India
  • Benedict M. Devereaux

    11   University of Queensland Medical School, Brisbane, Queensland, Australia
  • Jong Kyun Lee

    12   Samsung Medical Center, Seoul, Republic of Korea
  • Mahesh K. Goenka

    13   Apollo Gleneagles Hospital, Kolkata, India
  • Randhir Sud

    14   Medanta the Medicity, Gurgaon, India
  • Nam Q. Nguyen

    15   Royal Adelaide Hospital, Adelaide, South Australia, Australia
  • Rakesh Kochhar

    16   Postgraduate Institute of Medical Education and Research, Chandigarh, India
  • Joyce Peetermans

    17   Boston Scientific Corporation, Marlborough, Massachusetts, USA
  • Pooja G. Goswamy

    17   Boston Scientific Corporation, Marlborough, Massachusetts, USA
  • Matthew Rousseau

    17   Boston Scientific Corporation, Marlborough, Massachusetts, USA
  • Surya Prakash Bhandari

     1   Baldota Institute of Digestive Sciences, Global Hospital, Mumbai, Maharashtra, India
  • Phonthep Angsuwatcharakon

     2   Chulalongkorn University, Bangkok, Thailand
  • Raymond S. Y. Tang

     3   Prince of Wales Hospital, Shatin, Hong Kong
  • Anthony Y. B. Teoh

     3   Prince of Wales Hospital, Shatin, Hong Kong
  • Majid Almadi

     4   King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
  • Yun Nah Lee

    18   SoonChunHyang University Hospital, Bucheon, Republic of Korea
  • Jong Ho Moon

    18   SoonChunHyang University Hospital, Bucheon, Republic of Korea
  • the SpyGlass AMEA Registry Group
TRIAL REGISTRATION: Multi-center, prospective, non-randomized trial NCT02281019 at clinicaltrials.gov
Further Information

Publication History

submitted 15 November 2018

accepted after revision 25 April 2019

Publication Date:
27 June 2019 (online)

Preview

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.