scholarly journals Endoscopic Management of the Difficult Bile Duct Stones: A Single Tertiary Center Experience

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Bülent Ödemiş ◽  
Ufuk Barış Kuzu ◽  
Erkin Öztaş ◽  
Fatih Saygılı ◽  
Nuretdin Suna ◽  
...  
Keyword(s):  
Bile Duct ◽  
Endoscopic Management ◽  
Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
Stone Size ◽  
Biliary Clearance ◽  
Cbd Stones ◽  
Tertiary Center ◽  
Independent Risk Factors ◽  
Standard Techniques

Background. Most common bile duct (CBD) stones can be removed with standard techniques using endoscopic retrograde cholangiopancreatography (ERCP), but in some cases additional methods are needed. In this study we aimed to investigate the management of patients with difficult stones and the factors that affect the outcome of patients that have undergone periodic endobiliary stenting. Materials and Methods. Data of 1529 patients with naive papilla who had undergone ERCP with an indication of CBD stones was evaluated retrospectively. Stones that could not be removed with standard techniques were defined as “difficult stones.” Cholangiograms of patients who had difficult stones were revised prospectively. Results. Two hundred and eight patients (13.6%) had difficult stones; 150 of these patients were followed up with periodic endobiliary stenting and successful biliary clearance was achieved in 85.3% of them. Both CBD (p<0.001) and largest stone size (p<0.001) were observed to be significantly reduced between the first and the last procedure. This difference was even more significant in successfully treated patients. Conclusions. Periodic endobiliary stenting can be used as an effective treatment for patients with difficult stones. Sizes of the CBD and of the largest stone are independent risk factors that affect the success rate.

Underwater cap-assisted Endoscopic Retrograde Cholangiopancreatography in patients with surgically altered anatomy: a pilot study

Endoscopy ◽  
2020 ◽  
Author(s):  
Alessandro Fugazza ◽  
Andrea Anderloni ◽  
Danilo Paduano ◽  
Matteo Badalamenti ◽  
Roberta Maselli ◽  
...  
Keyword(s):  
Bile Duct ◽  
Adverse Events ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Management ◽  
Biliary Disease ◽  
Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
Promising Alternative ◽  
Surgically Altered Anatomy ◽  
Transparent Cap

Introduction Endoscopic retrograde cholangiopancreatography (ERCP) in surgically altered anatomy (SAA) pa-tients is technically challenging and associated with a significant number of failures. We examined the feasibility and efficacy of a novel technique for management of jaundice orcholangitis second-ary to bile duct stones (BDS), called underwater cap-assisted ERCP (u-ERCP). Methods Between June 2019 and February 2020 all patients with jaundice or cholangitis secondary to bile duct stones (BDS) with SAA who underwent u-ERCP were enrolled. The u-ERCP tecnnique combines the underwater advancement of a pediatric colonoscope with a transparent cap fitted on the tip of the endoscope. We evaluated the technical success, clinical suc-cess and adverse events associated with u-ERCP. Results We describe the technique itself and our first experience in 6 patients. A complete and successful procedure was carried out in all patients with no adverse events occurrence. None of the patients needed additional treatments for recurrence of symptoms during the follow-up period. Conclusions The u-ERCP can be considered as a promising alternative for successful endoscopic management of biliary disease in patients with SAA.

scholarly journals Two-stages using endoscopic retrograde cholangio-pancreatography procedures versus single stage laparoscopic management for concomitant gallstones and common bile duct stones

2019 ◽  
Vol 6 (12) ◽  
pp. 4244 ◽  
Author(s):  
Ahmed Abdel Kahaar Aldardeer ◽  
Alaa A. Redwaan
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Single Stage ◽  
Complication Rates ◽  
Bile Duct Stones ◽  
Two Stage ◽  
Endoscopic Retrograde ◽  
Cbd Stones ◽  
Group A ◽  
Group B

Background: Laparoscopic common bile duct exploration (LECBD) has been proven to be a safe, reliable, and effective treatment for common bile duct (CBD) stones and has gained wider acceptance. Endoscopic retrograde cholangio-pancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) is safe and efficient method that has been usually used for the treatment of bile duct stones. The aim of this study is to compare the outcome of management of concomitant gallstones and common bile duct by two stage (ERCP+LC) versus one stage (LECBD+LC).Methods: This study included 150 patients with concomitant gallstones and CBD stones who were treated at sohag university hospital from July 2017 to December 2018. Results were statistically analysed.Results: The success rates of laparoscopic CBD exploration and ERCP for clearance of CBD were similar (Group A 96% vs. Group B 97.3%). The mean operative time was significantly longer in-group A (125.7±36.6 min) vs. in-group B (82.4±27.6 min), Group A as regard intraoperative complications (one patient had hemorrhage) vs. group B (2 patients hemorrhage during lap. cholecystectomy). As for conversion to other procedure 2 patients for group A vs. 3 patients for group B (conversion of LC to open).Conclusions: Single and two-stage management for uncomplicated concomitant gallbladder and CBD stones had similar success and complication rates, but the single stage strategy was better in terms of shorter hospital stay, need for fewer procedures, less morbidity, and allows earlier recovery with a reduced period of short-term disability. 

CONCOMITANT GALLSTONES AND COMMON BILE DUCT STONES: SHOULD SINGLE-STEP LAPAROSCOPIC CHOLECYSTECTOMY IMMEDIATELY AFTER THE ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY?

2018 ◽  
Vol 8 (6) ◽  
pp. 99-104
Author(s):  
Vy Pham Trung ◽  
Hiep Pham Nhu ◽  
Vu Pham Anh ◽  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Common Bile Duct Stones ◽  
Single Step ◽  
Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
Female Ratio ◽  
Cbd Stones ◽  
Study Results

Purpose: To evaluate results from treatment of concomitant gallstones and common bile duct (CBD) stones by ERCP and laparoscopic cholecystectomy. Analysis of single-step or separated-step characteristics. Object: During the 3 years (2015-2017), 285 patients CBD stones concomitant or not gallstones underwent ERCP, 68 patients concomitant gallstones and CBD suitable criteria for inclusion at Hue Central Hospital. Retrospective clinical descriptive study. Results: Average age 52.2±12.5 (24-90), male/female ratio of 0.7/1 (27/41). Abdominal pain was the most common symptom 91.2%, jaundice 51.5%, direct bilirubin increased 27.3±15.6μmol/l (2.2-165). The diameter of CBD stone is 12.4±3.2mm (6-20), gallstones size 11.3±6.2mm (536). The first time CBD stones 95.6%, recurrence CBD stones 4.4%. ERCP and laparoscopic cholecystectomy (LC) 34patients, ERCP 1.4±2.5times and secondary LC. Single-step ductal clearance 76.5%, separatestep ductal clearance 94.1% (p=0.041). Length of hospital stay 6.5±4.3days and 13.6±2.2days (p<0.0001). Conclusions: The percentage of ductal clearance in the separate-step patients group was higher than that single-step patients group with p=0.041. The indication of cholecystectomy immediately endoscopic retrograde cholangio pancreatography should be based on the patient status, the ductal clearance as well as the complications. Key words: Common bile duct stones, Endoscopic retrograde cholangio pancreatography

Comparable Safety of ERCP in Symptomatic and Asymptomatic Patients with Common Bile Duct Stones: A Propensity-Matched Analysis

2020 ◽  
Author(s):  
Lina Xiao ◽  
Chong Geng ◽  
Xiao Li ◽  
Yanni Li ◽  
Chunhui Wang
Keyword(s):  
Bile Duct ◽  
Postoperative Complications ◽  
Common Bile Duct ◽  
Acute Cholangitis ◽  
Common Bile Duct Stones ◽  
Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
Cbd Stones ◽  
Asymptomatic Patients ◽  
Before And After

Abstract Background: The safety of endoscopic retrograde cholangiopancreatography (ERCP) for asymptomatic common bile duct (CBD) stones patients has not been fully studied. This study aimed to compare the incidence and severity of ERCP complications in patients with asymptomatic and symptomatic CBD stones and to provide evidence for the treatment of asymptomatic CBD stones.Methods: The clinical data of patients were retrospectively analyzed. These patients were divided into the asymptomatic CBD stones group and the symptomatic CBD stones group. Propensity score matching (PSM) was used to match the two groups. The incidence and severity of postoperative complications of ERCP in the two groups were analyzed.Results: A total of 79 patients who had asymptomatic CBD stones and 795 patients who had symptomatic CBD stones were included in this study. After PSM, 79 patients from asymptomatic CBD group and 316 patients from the symptomatic CBD stones group were identified. Before and after PSM, there were no significant differences in the incidence and severity of post-ERCP pancreatitis (PEP) between the two groups (P> 0.05). Besides, the incidence and severity of other complications including acute cholangitis, bleeding and perforation in the two groups was no differences before and after PSM (P>0.05).Conclusions: Patients with asymptomatic CBD stones are not at higher risk of getting ERCP-related complications when compared with those with symptomatic ones. ERCP is as safe and effective for asymptomatic CBD stones as for symptomatic patients.

scholarly journals Percutaneous Transhepatic Laser Lithotripsy for Biliary Stones in Patients with Altered Biliary Anatomy

2021 ◽  
Author(s):  
Jacob Indu ◽  
Vikrama Amitha Kheda ◽  
Deepak Bolbandi ◽  
Sanjay Govil ◽  
Ravisankar Bhat
Keyword(s):  
Bile Duct ◽  
Current Treatment ◽  
Laser Lithotripsy ◽  
Safe Procedure ◽  
Bile Duct Stones ◽  
Biliary Stones ◽  
Endoscopic Retrograde ◽  
Difficult Cases ◽  
Transhepatic Biliary Drainage ◽  
Variant Anatomy

AbstractEndoscopic retrograde cholangiopancreatography (ERCP) is the current treatment of choice in bile duct stones. Several factors such as variant anatomy of ampulla and surgical procedures like hepaticojejunostomy limit the success of ERCP in treating bile duct stones. Percutaneous transhepatic laser lithotripsy using interventional radiologic and endourologic techniques, which is uncommon, is a reasonable treatment option in such difficult cases. It is a minimally invasive, safe procedure accompanied by a high success rate, minimal morbidity, and a short hospital stay. We report our technique and experience in a series of three patients who underwent percutaneous transhepatic biliary drainage (PTBD) followed by percutaneous transhepatic laser lithotripsy in an attempt to avoid open surgery when ERCP was technically difficult.

scholarly journals Surgical procedure for unexpected balloon burst complication during endoscopic balloon dilatation in a patient with common bile duct stones

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Koji Morishita ◽  
Hideaki Sasaki
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Balloon Dilatation ◽  
Rare Complication ◽  
Common Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
Case Presentation ◽  
Endoscopic Balloon Dilatation ◽  
Cbd Stones ◽  
Endoscopic Balloon

Abstract Background Endoscopic balloon dilatation (EBD) is the established treatment for common bile duct (CBD) stones. Although pancreatitis and bleeding have been reported as major complications of EBD, balloon-related complications are rarely reported in EBD. Case presentation A 30-year-old woman with suspected CBD stones underwent endoscopic retrograde cholangiopancreatography (ERCP) and EBD. During EBD, the balloon of the EBD catheter suddenly burst at the biliary sphincter. We therefore performed surgical intervention: removal of the broken EBD catheter and T-tube drainage. Finally, the patient was discharged without any complications. Conclusions We present a case involving a burst balloon of an EBD catheter as a rare complication during EBD, as well as the surgical technique that was used to treat this complication.

scholarly journals Management of choledocholithiasis after previous gastrectomy

2017 ◽  
Vol 99 (7) ◽  
pp. e213-e215
Author(s):  
S Anwer ◽  
R Egan ◽  
N Cross ◽  
S Guru Naidu ◽  
K Somasekar
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Common Bile Duct Stones ◽  
Bile Duct Stones ◽  
Successful Management ◽  
Endoscopic Retrograde ◽  
Technical Challenge

Common bile duct stones in patients with a previous gastrectomy can be a technical challenge because of the altered anatomy. This paper presents the successful management of two such patients using non-traditional techniques as conventional endoscopic retrograde cholangiopancreatography was not possible.

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