Endoscopy 2020; 52(S 01): S31
DOI: 10.1055/s-0040-1704097
ESGE Days 2020 oral presentations
Saturday, April 25, 2020 08:30 – 10:30 Cholangioscopy: Current status Liffey Hall 2
© Georg Thieme Verlag KG Stuttgart · New York

SINGLE-OPERATOR PERORAL CHOLANGIOSCOPY-GUIDED LITHOTRIPSY FOR DIFFICULT BILIARY STONES - A PROSPECTIVE MULTICENTER STUDY

M Moreira
1   Santa Luzia Hospital - Unidade Local de Saúde Alto Minho, Gastroenterology, Viana do Castelo, Portugal
,
D Costa
1   Santa Luzia Hospital - Unidade Local de Saúde Alto Minho, Gastroenterology, Viana do Castelo, Portugal
2   Hospital de Braga, Gastroenterology, Braga, Portugal
,
G Alexandrino
3   Professor Doutor Fernando Fonseca Hospital, Gastroenterology, Amadora, Portugal
,
J Fernandes
1   Santa Luzia Hospital - Unidade Local de Saúde Alto Minho, Gastroenterology, Viana do Castelo, Portugal
,
T Araújo
1   Santa Luzia Hospital - Unidade Local de Saúde Alto Minho, Gastroenterology, Viana do Castelo, Portugal
,
L Lourenço
3   Professor Doutor Fernando Fonseca Hospital, Gastroenterology, Amadora, Portugal
,
S Campos
4   Hospital Garcia da Horta, Gastroenterology, Almada, Portugal
,
D Horta
3   Professor Doutor Fernando Fonseca Hospital, Gastroenterology, Amadora, Portugal
,
Tiago Bana e Costa
5   CHLO - Hospital Egas Moniz, Gastroenterology, Lisbon, Portugal
,
Luís Lopes
1   Santa Luzia Hospital - Unidade Local de Saúde Alto Minho, Gastroenterology, Viana do Castelo, Portugal
6   Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
7   ICVS/3B’s - PT Government Associate Laboratory, Braga/Guimarães, Portugal
,
Jorge Canena
3   Professor Doutor Fernando Fonseca Hospital, Gastroenterology, Amadora, Portugal
8   Nova Medical School-Faculty of Medical Sciences, Lisboa, Portugal
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    Aims ERCP is the first choice for removal of biliary stones. In difficult stones, advanced therapeutic techniques, such as electrohydraulic lithotripsy (EHL) and laser lithotripsy (LL) have been proposed. Recently, the availability of single-operator cholangioscopy (SOC) turned these techniques more accessible and easier to perform. We sought to evaluate the clinical efficacy and safety of SOC guided-lithotripsy using EHL or LL in patients with complex biliary stones.

    Methods A prospective study was carried out in 5 hospitals, comprising 57 consecutive patients with complicated biliary stone treated with SpyGlass DS (Boston Scientific, Marlborough, United States) guided-lithotripsy using EHL or Holmium LL. We analyzed the complete cleaning of the ducts, the incidence of adverse events, the impact of the number of stones and its location on clinical success, and the performance of the 2 lithotripsy modalities.

    Results 42 patients (73.68%) had common bile duct/common hepatic duct stones, 8 patients (14.04%) had a single cystic stump stone and 7 patients (12.28%) had intrahepatic stones. 45 patients (78.95%) were successfully treated in one procedure and the remaining 12 patients (21.05%) required additional sessions to obtain cleaning of the ducts. 36 patients were treated with LL: 29 (85.29%) achieved clinical success in a single session with a single laser fiber. 21 patients were treated with EHL: 8 patients (38.09%) were clinically successful in a single 1-fiber session; 8 patients required 2 fibers to obtain ductal cleansing in a single session. Complications were mild in 11/51 (21.15%) patients and included fever (n = 5), mild pancreatitis (n = 4), mild cholangitis (n = 2).

    Conclusions Guided-lithotripsy SOC using EHL or LL in patients with difficult biliary stones is very effective and is associated with transient and mild complications. Although further studies are needed there is an apparent advantage in the use of laser technology.


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