CHOLANGIOSCOPY-GUIDED LITHOTRIPSY IN THE TREATMENT OF DIFFICULT BILE DUCTS STONES- DATA FROM TWO TERTIARY REFERRAL CENTERS

Aims To evaluate the efficacy and safety of D-SOC- guided lithotripsy in cases of difficult bile ducts stones and to analyze factors, related to adverse events and procedure time.

Methods Retrospective review of prospective databases from two tertiary referral centers including 38 patients with difficult bile ducts stones was performed. All the patients had previous ERCPs and at least one unsuccessful attempt for stone removal. We performed DSOC-guided lithotripsy using EHL or LL, following standard protocol. The primary endpoint was achieving ductal clearance, confirmed by negative occlusive cholangiogram. We also explored the incidence of complications, factors, associated with them and variables affecting the procedure duration.

Results For the study period (03.2016-04.2019) 38 patients were treated with D-SOC- guided lithotripsy (33 with LL and 5 with EHL). Complete ductal clearance was achieved in 92,1%, in 78,9 % in one session. Average number of procedures until complete stone removal was 1,22 (1-3). The mean procedure time for EHL was 83 min and for LL 115 min. Complications were observed in 4 (10,5%) patients. All were defined as mild. There was no correlation between age, size of stone, duration of the procedure and amount of saline used during lithotripsy and occurrence of complications. The presence of a stricture, barrel shaped or irregular shaped stones was associated with increased risk of complications (p< 0.05). Large stones, multiple lithiasis, intrahepatic location and failed previous EPLBD/ML were related to prolonged procedure time (p< 0.05).

Conclusions SOC- guided lithotripsy is highly effective and safe procedure. The presence of a distal CBD stricture and complex shape of stones is associated with higher risk of procedure complications