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1.
Jin-Seok Park Seok Jeong Jee Young Han Don Haeng Lee 《Digestive diseases and sciences》2014,59(8):1898-1901
Background/Aim
Endoscopic treatment for removal of large or impacted bile duct stones is challenging, and may not be successful. The aim of this study was to evaluate the safety and efficacy of endoscopic balloon dilation lithotripsy (EBDL) as a means of treating difficult extrahepatic bile duct stones refractory to failed conventional endoscopic treatments.Patients and Methods
The patients were included in the indication of EBDL only if stones were confirmed as brown-pigmented stones or recurrent. Balloon dilation was performed using a balloon dilation catheter in order to crush large and/or impacted stones at the common hepatic duct or common bile duct level in seven cases, and then fragmented stones were removed using a basket and/or an extraction balloon catheter.Results
The median diameter of the balloons used for EBDL was 32.4 ± 10.5 mm (range, 12.4–52.1). Balloon dilation was performed for 60 s per session. The mean number of EBDL sessions required to crush stones was two (range, 1–5), the mean number of ERCP sessions required for complete stone removal was 2.4 ± 0.8 (range, 1–3), the overall procedure-related complication rate was 0 % (0/7), and the success rate was 100 % (7/7).Conclusion
EBDL might be a safe and effective option for the treatment of large and impacted extrahepatic bile duct stones refractory to conventional endoscopic treatments. 相似文献2.
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Purpose of Review
In 10–15% of the cases, conventional methods for removing bile duct stones by ERCP/balloon-basket extraction fail. The purpose of this review is to describe endoscopic techniques in managing these “difficult bile duct stones.”Recent Findings
Endoscopic papillary large balloon dilation with balloon extraction ± mechanical lithotripsy is the initial approach used to retrieve large bile duct stones. With advent of digital cholangioscopy, electrohydraulic and laser lithotripsy are gaining popularity. Enteroscopy-assisted or laparoscopic-assisted approaches can be used for those with gastric bypass anatomy.Summary
Difficulties in removing bile duct stones can be related to stone-related factors such as the size and location of the stone or to altered anatomy such as stricture in the bile duct or Roux-en-Y anatomy. Several endoscopy approaches and techniques have described in the recent past that have greatly enhanced our ability to remove these “difficult” bile duct stones.4.
C. M. Lo M.B. B.S. F.R.C.S. S. T. Fan M.B. B.S. F.R.C.S. F.A.C.S. 《The American journal of gastroenterology》1991,86(7):840-842
Choledochoscopic electrohydraulic lithotripsy was applied through a percutaneous transhepatic approach in four high-risk patients with common bile duct stones that were not extractable by duodenoscopic means. All stones were fragmented and removed from three patients, but one patient died from bronchopneumonia before ductal clearance could be achieved. The procedure was well tolerated, without any complication. The major disadvantage is the multiple maneuvers required and the prolonged hospital stay. Percutaneous transhepatic choledochoscopic electrohydraulic lithotripsy provides a safe and effective alternative for nonoperative treatment of common bile duct stones in high-risk patients when the duodenoscopic approach fails. 相似文献
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J. Weber M.D. H. E. Adamek M.D. J. F. Riemann M.D. 《The American journal of gastroenterology》1991,86(2):196-200
Today, common bile duct stones are extracted endoscopically. After endoscopic sphincterotomy, nearly 90% of all stones can be removed with a Dormia basket or a mechanical lithotripter. Problems are encountered if there are larger stones or a duct stenosis. New conservative therapies do serve as an alternative to surgical intervention for those few patients in whom endoscopic measures have failed. Stone fragmentation can be achieved by extracorporeal shock wave lithotripsy, and remaining fragments can be removed endoscopically. So far, authors of most reports on the successful disintegration of common bile duct stones used the Dornier lithotripter. Stone localization is thus achieved with x-rays, and the shock waves are generated by an underwater spark discharge. We report on our experiences and results with extracorporeal piezoelectric shock wave lithotripsy (EPL) in 19 patients with complicated bile duct stones. With this lithotripter, stones are visualized by ultrasound, and shock waves are produced by a piezoelectric acoustic generator. Fragmentation was achieved in 84.2%, and complete stone removal in 78.9%. These results show that piezoelectric lithotripsy is also a useful method for the treatment of complicated bile duct stones, as has already been proved for the electrohydraulic- and electromagnetic-generated shock waves systems. However, the renunciation of general anesthesia and the need for analgesia or sedation in only 25% of the treatments render this lithotripter system attractive, especially for elderly and frail patients. 相似文献
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Olaya I. Brewer Gutierrez Noor L.H. Bekkali Isaac Raijman Richard Sturgess Divyesh V. Sejpal Hanaa D. Aridi Stuart Sherman Raj J. Shah Richard S. Kwon James L. Buxbaum Claudio Zulli Wahid Wassef Douglas G. Adler Vladimir Kushnir Andrew Y. Wang Kumar Krishnan Vivek Kaul Demetrios Tzimas Mouen A. Khashab 《Clinical gastroenterology and hepatology》2018,16(6):918-926.e1
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Li-Wu QIAN Hirouyki KONOMI Hiroshi KIMURA Kazunori YOKOHATA Yoshiaki OGAWA Kazuo CHUIIWA Georgi P. DEENITCHIN Masao TANAKA 《Digestive endoscopy》1995,7(2):171-174
Although stenosis is regarded as one of the causes of recurrence of common bile duct stones after endoscopic sphincterotomy, there is a lack of direct evidence. Endoscopic retrograde cholangiography and manometry were performed in 131 patients 2.2–111.1 months (mean 29.9 months) after sphincterotomy, either for follow-up or at presentation of biliary symptoms. Recurrent stones were found in 33 patients (25%) (recurrent group). The remaining 98 patients (75%) proved not to have recurrence (nonrecurrent group). The common bile duct-to-duodenum pressure gradient in the recurrent group (3.3 ± 1.4 mmHg, mean ±SEM) did not differ from that in the nonrecurrent group (2.9 ±1.5 mmHg) (p=0.85). However, as judged by endoscopic findings, we found a significantly elevated frequency of stenosis of the spincter-otomy orifice in the recurrent group (4 of 33 patients) as compared with the nonrecurrent group (none of 98 patients) (p=0.0035). Recurrence of common bile duct stones appears to correlate with stenosis following sphincterotomy, although manometry does not necessarily indicate the presence of stenosis. 相似文献
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René den Toom M.D. Huub G. T. Nijs M.D. Mark van Blankenstein M.D. Fritz H. Schröder M.D. Johannes Jeekel M.D. Onno T. Terpstra M.D. 《The American journal of gastroenterology》1991,86(8):1033-1066
Chronic calcifying pancreatitis presents a major clinical problem, often requiring extensive surgery. Extracorporeal shock wave lithotripsy (ESWL) offers a new therapeutic option. We applied ESWL after endoscopic sphincterotomy of the pancreatic orifice in eight patients with impacted pancreatic duct stones. An electromagnetic lithotriptor (Siemens Lithostar, Erlangen, FRG) was used. Patients were treated in prone position under fluoroscopic control. A mean of 6,813 shock waves (range 1,500-10,000) was delivered in one or two sessions. Disintegration of stones was achieved in 6/8 patients, initial relief of pain in 7/8 patients, and total clearance of the pancreatic duct in 3/8 patients. One patient had an exacerbation of her pancreatitis one day after ESWL, which resolved rapidly with medical treatment. No other complications were observed. Four of five patients with fragmented stones had no abdominal complaints at follow-up (mean 17 months, range 3-27). Three patients in whom ESWL was not completely successful (two without and one with partial fragmentation) underwent an operation according to Puestow. Two of them still have abdominal complaints after surgery. From these data, we conclude that ESWL of pancreatic duct stones is a promising new alternative for surgery, when endoscopic stone extraction fails. 相似文献
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Durn-Martnez Manuel Martnez-Cecilia David Martnez-Isla Alberto 《Digestive diseases and sciences》2022,67(9):4590-4592
Digestive Diseases and Sciences - 相似文献
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Tatsuro Wakayama M.D. Tohru Itoh M.D. Yasushi Takeda M.D. Tomoo Kosuge M.D. Kazuaki Shimada M.D. Yuji Nomura M.D. Kazuyuki Shimomura M.D. Yasuo Idezuki M.D. F.A.C.S. 《The American journal of gastroenterology》1990,85(9):1168-1171
We report the successful treatment of bilateral intrahepatic biliary stones by endoscopic electrohydraulic lithotripsy (EHL). EHL is a useful procedure by which large stones can be fragmented easily and complete removal of stones can be attained. 相似文献
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Won Myung Lee Jong Ho Moon Yun Nah Lee Il Sang Shin Tae Hoon Lee Jae Kook Yang Sang-Woo Cha Young Deok Cho Sang-Heum Park 《Gut and liver》2022,16(4):599
Background/AimsTreatment options for difficult bile duct stones are limited. Direct peroral cholangioscopy (POC)-guided lithotripsy may be an option. A newly developed multibending (MB) ultraslim endoscope has several structural features optimized for direct POC. We evaluated the utility of direct POC using an MB ultraslim endoscope for lithotripsy in patients with difficult bile duct stones.MethodsTwenty patients with difficult bile duct stones, in whom stone removal using conventional endoscopic methods, including mechanical lithotripsy, had failed were enrolled from March 2018 to August 2019. Direct POC-guided lithotripsy was performed by electrohydraulic lithotripsy or laser lithotripsy. The primary outcome was complete ductal clearance, defined as the retrieval of all bile duct stones after lithotripsy confirmed by balloon-occluded cholangiography and/or direct POC.ResultsThe technical success rate of direct POC was 100% (20/20), and the free-hand insertion rate was 95% (19/20). Direct POC-guided lithotripsy, attempted by electrohydraulic lithotripsy in nine patients (45%) and laser lithotripsy in 11 patients (55%), was successful in 95% (19/20) of the patients. Complete ductal clearance after direct POC-guided lithotripsy was achieved in 95% (19/20) of patients. Patients required a median of 2 (range, 1–3) endoscopic retrograde cholangiopancreatography sessions for complete stone removal. Adverse event was observed in one patient (5%) with hemobilia and was treated conservatively.ConclusionsDirect POC using an MB ultraslim endoscope was safe and effective for lithotripsy in patients with difficult bile duct stones. 相似文献
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Abstract: Although endoscopic balloon sphincter dilation (EBSD) appears to be an attractive treatment modality, the rate of bile duct clearance is apparently reduced due to limited enlargement of the bile duct opening when the stones are large and/or numerous. We present the case of an 87-year-old woman who developed an extremely large bile duct stone. To crush the stone sufficiently to allow grasping by a mechanical lithotriptor or a basket catheter with the EBSD procedure, extracorporeal shock wave lithotripsy was performed and the fragments were removed successfully. 相似文献
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Ahmed Abdel-Raouf Emad Hamdy Ehab El-Hanafy Gamal El-Ebidy 《Saudi Journal Of Gastroenterology》2010,16(1):19-24
Background/Aim:
Biliary endoscopic procedures may be less invasive than surgery for management of postoperative bile duct injuries (POBDI). This retrospective work presents the experience of a single referral center during a period of 14 years in endoscopic management of POBDI.Patients and Methods:
Between 1994 (March) and 2008 (May), ERCP had been performed on 277 patients suspected to have POBDI. Patients shown to have complete transaction of bile duct were prepared for definitive surgery. For patients with simple biliary leak, sphincterotomy was performed with stenting. Pneumatic dilatation and stenting were done on patients with biliary stricture and preserved ductal continuity. ERCP was repeated every 3 months till the site of narrowing disappeared.Results:
The mean age was 45.3 years, 162 (58.5%) were females. The most common previous surgery was cholecystectomy (open, [N=119] 44%, and laparoscopic, [N=77] 28%). ERCP failed in 17 patients (6.1%). For successfully cannulated cases (N=260, 93.9%), the type of bile duct injury diagnosed at ERCP was completely ligated CBD (N=31/260 , 11.9%). Bile leakage was detected in (N=167/260, 64.2%) all patients with endoscopic sphincterotomy and stent insertion, the leak stopped in all of them. Biliary stricture was diagnosed in 33/260 patients (12.7%) and 17 of them had repeated balloon dilatation with stenting while the remaining had surgical correction. The success rate of endoscopic therapy for biliary strictures was 82%. Cholangiogram was normal in 29 patients (11.2%).Conclusions:
Endoscopic therapy is safe and effective in the management of postoperative bile duct leak. For postoperative bile ductal strictures, ERCP is a less favorable option. 相似文献19.
Sang Eon Jang Dong-Won Ahn Sang Hyub Lee Ban Seok Lee Ji Bong Jeong Jin-Hyeok Hwang Ji Kon Ryu Yong-Tae Kim Kyoung Ho Lee Young Hoon Kim 《Digestive diseases and sciences》2013,58(8):2353-2360