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Titel: Tandem Standard-Size and ("Diagnostic") Ultra-Slim Cholangioscopy to Guide and Validate Completeness of Mechanical Lithotripsy
VerfasserIn: Zimmer, Vincent
Sprache: Englisch
Titel: GE Portuguese Journal of Gastroenterology
Bandnummer: 29 (2022)
Heft: 4
Seiten: 293-295
Verlag/Plattform: Karger
Erscheinungsjahr: 2021
Freie Schlagwörter: Complex bile duct stone disease
Endoscopic retrograde cholangiopancreatography
Cholangioscopy
Endoscopy
Cholecystectomy
Lithotripsy
DDC-Sachgruppe: 610 Medizin, Gesundheit
Dokumenttyp: Journalartikel / Zeitschriftenartikel
Abstract: An 86-year-old patient with a prior history of cholecystectomy was referred for endoscopic retrograde cholangiopancreatography (ERCP) due to stone-related cholangitis. At the index ERCP, biliary drainage using a 10-Fr double-pigtail stent was established after limited papillotomy. Repeat ERCP including adequate contrast application indicated marked biliary dilation with distal tapering and > 8 large, partly barrel-shaped stones > 15 mm (Fig. 1a). After 2 ERCP sessions including large-balloon dilation to 13.5 mm, and multiple mechanical lithotripsies (MLs), the biliary stone burden was markedly diminished. However, a smooth distal tapering of the distal common bile duct (CBD), most likely attributable to high mechanical stress from multiple stone and/or ML fragment extractions, emerged at the 3rd ERCP, with a remaining large stone detected above the relative stricture. Given the transient unavailability of electrohydraulic lithotripsy (EHL) at our institution, we opted for standard-size direct cholangioscopy ([DC], outer-scope diameter 9.8 mm and working-channel 2.8 mm) after freehand intubation to cope with failed stone capture by conventional ERCP technology as a sine qua non for proceeding with ML. Direct endoscopic visualization likewise replicated a scarred, unpassable bile duct stricture with visible stone material higher in the CBD (Fig. 1b). Under endoscopic vision, a rotable retrieval basket was introduced and the stone was successfully grasped (Fig. 1c). Next, ML, using a rescue lithotripter, was performed under fluoroscopic guidance (Fig. 1d). This was followed by the flushing out and extraction of some smaller ML fragments, and a final “diagnostic” ultra-slim DC (outer diameter 5.9 mm; working channel 2.0 mm) able to pass the stricture excluded remnant biliary stone disease throughout the biliary system (Fig. 1e). 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].
DOI der Erstveröffentlichung: 10.1159/000516140
URL der Erstveröffentlichung: https://doi.org/10.1159/000516140
Link zu diesem Datensatz: urn:nbn:de:bsz:291--ds-399467
hdl:20.500.11880/35943
http://dx.doi.org/10.22028/D291-39946
ISSN: 2387-1954
Datum des Eintrags: 12-Jun-2023
Fakultät: M - Medizinische Fakultät
Fachrichtung: M - Innere Medizin
Professur: M - Keiner Professur zugeordnet
Sammlung:SciDok - Der Wissenschaftsserver der Universität des Saarlandes

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