Please use this identifier to cite or link to this item: doi:10.22028/D291-39947
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Title: Cystic Duct Leakage as Visualized by Novel Digital Single-Operator Cholangioscopy (with Video)
Author(s): Zimmer, Vincent
Language: English
Title: GE Portuguese Journal of Gastroenterology
Volume: 29 (2022)
Issue: 5
Pages: 369-370
Publisher/Platform: Karger
Year of Publication: 2021
Free key words: Cholecystectomy
Cystic duct leakage
Endoscopic retrograde choangiopancreatography
DDC notations: 610 Medicine and health
Publikation type: Journal Article
Abstract: An 80-year-old male patient underwent endoscopic retrograde cholangiopancreatography (ERCP) due to moderate cholestasis (bilirubin 2.3 mg/dL) and bile duct dilation >12 mm as well as cholecystolithiasis on abdominal ultrasound. After difficult biliary access including transpancreatic sphincterotomy and pancreatic duct stenting, cholangiography indicated prepapillary impaction of a large stone >15 mm, defying basket capture for mechanical lithotripsy. The patient was referred for cholecystectomy after implantation of a 10-Fr, 11-cm biliary plastic stent. Of note, the cholecystectomy had to be converted to open surgery due to marked adhesions, but the postoperative course was otherwise uncomplicated. The postoperative ERCP 4 weeks later indicated persistent stone impaction in the prepapillary segment not to be extracted by conventional techniques (Fig. 1a). Of note, faint contrast extravasation from the cystic duct (CD) was noted, consistent with clinically well-compensated CD leakage, such that repeat bile duct stenting was performed. Single-operator digital cholangioscopy using the Spyglass DS platform (Boston Scientific) to guide electrohydraulic lithotripsy (EHL) was scheduled and performed without complications 6 weeks later (Fig. 1b). EHL fragments were removed and no remnant stones were detected. However, the initial and dedicated cholangiography replicated a cloud of contrast extravasation correlating to persistent CD leakage despite >8 weeks of biliary plastic stenting (Fig. 1c). Following this, the CD branch-off was selectively intubated (Fig. 1d), and the small underlying defect was visualized by cholangioscopy (Fig. 1e; online suppl. Video, for all online suppl. material, see and fluoroscopy [1]. Due to ongoing CD leakage despite plastic stenting for >10 weeks and taking the small-volume fistula into consideration, the patient underwent implantation of a fully covered self-expanding metal stent as a mature and easy-to-implement rescue approach in this setting (Fig. 1f) [2]. Repeat ERCP after 3 months, including balloon occlusion cholangiography, demonstrated no persistent leakage or remnant stones (Fig. 1g).
DOI of the first publication: 10.1159/000516949
URL of the first publication:
Link to this record: urn:nbn:de:bsz:291--ds-399474
ISSN: 2387-1954
Date of registration: 12-Jun-2023
Description of the related object: Supplementary Material
Related object:
Faculty: M - Medizinische Fakultät
Department: M - Innere Medizin
Professorship: M - Keiner Professur zugeordnet
Collections:SciDok - Der Wissenschaftsserver der Universität des Saarlandes

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