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Outcomes of Single-Operator Cholangioscopy-Guided Lithotripsy in Patients with Difficult Biliary and Pancreatic Stones

2019Artigo científico Acesso aberto
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dc.contributor.authorCanena, Jorge
dc.contributor.authorCanena, Jorge
dc.contributor.authorLopes, Luís
dc.contributor.authorFernandes, João
dc.contributor.authorAlexandrino, Gonçalo
dc.contributor.authorLourenço, Luís
dc.contributor.authorLibânio, Diogo
dc.contributor.authorHorta, David
dc.contributor.authorGiestas, Sílvia
dc.contributor.authorReis, Jorge
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblKarger
dc.date.accessioned2018-06-05T22:12:30Z
dc.date.available2018-06-05T22:12:30Z
dc.date.issued2019
dc.description.abstractBackground and Aims: Endoscopic retrograde cholangiopancreatography is the preferred strategy for the management of biliary and pancreatic duct stones. However, difficult stones occur, and electrohydraulic (EHL) and laser lithotripsy (LL) have emerged as treatment modalities for ductal clearance. Recently, single-operator cholangioscopy was introduced, permitting the routine use of these techniques. We aimed to evaluate the clinical effectiveness of cholangioscopy-guided lithotripsy using LL or EHL in patients with difficult biliary or pancreatic stones. Methods: This is a prospective clinical study – conducted at two affiliated university hospitals – of 17 consecutive patients with difficult biliary and pancreatic stones who underwent single-operator cholangioscopy-guided lithotripsy using two techniques: holmium laser lithotripsy (HL) or bipolar EHL. We analyzed complete ductal clearance as well as the impact of the location and number of stones on clinical success and evaluated the efficacy of the two techniques used for cholangioscopy-guided lithotripsy and procedural complications. Results: Twelve patients (70.6%) had stones in the common bile duct/common hepatic duct, 2 patients (17.6%) had a stone in the cystic stump, and 3 patients (17.6%) had stones in the pancreas. Sixteen patients (94.1%) were successfully managed in 1 session, and 1 patient (5.9%) achieved ductal clearance after 3 sessions including EHL, LL, and mechanical lithotripsy. Eleven patients were successfully submitted to HL in 1 session using a single laser fiber. Six patients were treated with EHL: 4 patients achieved ductal clearance in 1 session with a single fiber, 1 patient obtained successful fragmentation in 1 session using two fibers, and 1 patient did not achieve ductal clearance after using two fibers and was successfully treated with a single laser fiber in a subsequent session. Complications were mild and were encountered in 6/17 patients (35.2%), including fever (n = 3), pain (n = 1), and mild pancreatitis (n = 1). Conclusions: Cholangioscopy-guided lithotripsy using LL or EHL in patients with difficult biliary or pancreatic stones is highly effective with transient and minimal complications. There is a clear need to further compare EHL and HL in order to assess their role in the success of cholangioscopy-guided lithotripsy.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent9
dc.format.extent9062182
dc.identifier.doi10.1159/000488508
dc.identifier.issn2341-4545
dc.identifier.otherPURE: 4310769
dc.identifier.otherPURE UUID: 3d18f947-1b04-47e4-999b-038e0fe9566f
dc.identifier.otherScopus: 85047124453
dc.identifier.otherPubMed: 30976615
dc.identifier.otherWOS: 000573273500006
dc.identifier.urihttp://www.scopus.com/inward/record.url?scp=85047124453&partnerID=8YFLogxK
dc.identifier.urlhttps://www.scopus.com/pages/publications/85047124453
dc.language.isoeng
dc.peerreviewedyes
dc.subjectCholangioscopy
dc.subjectElectrohydraulic lithotripsy
dc.subjectEndoscopic retrograde cholangiopancreatography
dc.subjectLaser lithotripsy
dc.subjectGastroenterology
dc.titleOutcomes of Single-Operator Cholangioscopy-Guided Lithotripsy in Patients with Difficult Biliary and Pancreatic Stonesen
dc.typejournal article
degois.publication.firstPage105
degois.publication.issue2
degois.publication.lastPage113
degois.publication.titleGE Portuguese Journal of Gastroenterology
degois.publication.volume26
dspace.entity.typePublication
person.familyNameCanena
person.givenNameJorge
person.identifier.orcid0000-0002-2539-5876
person.identifier.ridI-1379-2015
person.identifier.scopus-author-id6507619160
rcaap.rightsopenAccess
relation.isAuthorOfPublicationc8b48309-6089-430b-834c-46b5f79108bc
relation.isAuthorOfPublication.latestForDiscoveryc8b48309-6089-430b-834c-46b5f79108bc

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