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Minerva Gastroenterology 2021 Jul 09

DOI: 10.23736/S2724-5985.21.02892-8

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Digital single‑operator cholangioscopy in treating difficult biliary stones: results from a multicenter experience

Socrate PALLIO 1, Emanuele SINAGRA 2, 3 , Alessio SANTAGATI 4, Fabio D'AMORE 4, Francesca ROSSI 2, Giuseppe CONOSCENTI 2, Fabio ROMEO 4, Eleonora BORINA 4, Roberta BELLERONE 4, Marcello MAIDA 5, Rita ALLORO 6, Ilaria TARANTINO 7, Dario RAIMONDO 1

1 Endoscopy Unit, AOUP G. Martino, Messina, Italy; 2 Endoscopy Unit, Fondazione Istituto G. Giglio, Cefalù, Palermo, Italy; 3 Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy; 4 Endoscopy Unit, San Vincenzo Hospital, Taormina, Messina, Italy; 5 Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy; 6 Emergency Unit, Fondazione Istituto G. Giglio, Cefalù, Palermo, Italy; 7 Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCSISMETT (Mediterranean Institute for Transplantation and Highly Specialized Therapies), Palermo, Italy


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BACKGROUND: In clinical practice, standard endoscopic treatment of biliary stones fails in up to 10% of patients, and more invasive procedures such as percutaneous trans-hepatic interventions or surgery might become necessary. The aim of this multi-center retrospective study, based on prospectively-collected data, was to evaluate both the efficacy and the safety of Digital-Single Operator Cholangioscopy (D-SOC) to treat difficult biliary stones, in cases with a previous failure of conventional endoscopic methods.
METHODS: Only patients with a previous failure of endoscopic standard treatment and a DSOC- based biliary stone treatment using electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL) were included. The primary endpoint was to evaluate the stone clearance rate per procedure and per patient. Out of 1258 ERCP performed at our (three?) centers, 31 cholangioscopies in 21 patients were solely performed for the treatment of difficult biliary stones using EHL or LL.
RESULTS: A complete biliary stone removal was achieved in 67.7% (21/31) of all procedures including initial and repeated examinations, while in 35.4% (11/31) of all procedures an incomplete removal was accomplished of which 36.3% had a partial stone removal. In 22 procedures EHL was adopted as techniques to fragment and remove biliary stones, while in 9 procedures LL was used. In both the techniques, the complete stone removal rate and the incomplete stone removal rate were similar (75% vs 77.7%, p>.05). Furthermore, the success rate of digital DSOC to treat difficult biliary stones was assessed per patient: overall, 100% of patients with difficult biliary stones were successfully treated using D-SOC. Only one patient experienced mild cholangitis classified ad mild adverse event following ASGE (American Society of Gastrointestinal Endoscopy) lexicon.
CONCLUSIONS: In conclusion, our data indicate that digital D-SOC assisted biliary stone treatment is highly efficient for the treatment of difficult biliary stones even in such patients in whom previous conventional endoscopic methods to treat biliary stones have failed. Therefore, D-SOC might be considered the new standard of care for these patients, being both, effective and safe.


KEY WORDS: Difficult biliary stones; Cholangioscopy; Digital single operator cholangioscopy spyglass; Treatment

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