Feasibility study of endoscopic biliary drainage under direct peroral cholangioscopy by using an ultra-slim upper endoscope (with videos)

Abstract

The therapeutic utility of peroral cholangioscopy (POC) is limited. Direct POC using an ultra‑slim upper endoscope expands the therapeutic indications because of its larger working channel, of up to 2.2 mm. We evaluated the feasibility of selective biliary drainage using a plastic stent under direct POC. From April 2015 to March 2019, biliary drainage under endoscopic visualization was performed in the same endoscopic session as direct POC without exchanging the duodenoscope. After guidewire insertion through the stricture or stone, a 5 Fr plastic stent and/or nasobiliary drainage catheter was used for biliary drainage. Selective biliary drainage under direct POC was performed in 32 patients, including 17 with difficult bile duct stones. Biliary drainage was performed with a plastic stent in 29 patients, nasobiliary drainage in one, and combined drainage in two patients. The technical success rate for biliary drainage placement under direct POC was 100 % (32/32). No significant procedure-related complications occurred. In conclusion, biliary drainage with a plastic stent or catheter under direct POC using an ultra-slim upper endoscope is feasible and may be useful for lesions obstructing the bile duct.

Publikationsverlauf

Eingereicht: 25. Februar 2020

Angenommen: 30. Dezember 2020

Artikel online veröffentlicht:
16. September 2021

• References

• 1 Moon JH, Terheggen G, Choi HJ. et al. Peroral cholangioscopy: diagnostic and therapeutic applications. Gastroenterology 2013; 144: 276-282
• 2 Lee YN, Moon JH, Choi HJ. et al. A newly modified access balloon catheter for direct peroral cholangioscopy by using an ultraslim upper endoscope (with videos). Gastrointest Endosc 2016; 83: 240-247
• 3 Moon JH, Ko BM, Choi HJ. et al. Intraductal balloon-guided direct peroral cholangioscopy with an ultraslim upper endoscope (with videos). Gastrointest Endosc 2009; 70: 297-302
• 4 Chandrasekhara V, Khashab MA, Muthusamy VR. et al. Adverse events associated with ERCP. Gastrointest Endosc 2017; 85: 32-47
• 5 Weinberg BM, Shindy W, Lo S. Endoscopic balloon sphincter dilation (sphincteroplasty) versus sphincterotomy for common bile duct stones. Cochrane Database Syst Rev 2006; Cd004890
• 6 Freeman ML, Nelson DB, Sherman S. et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996; 335: 909-919
• 7 Waxman I, Chennat J, Konda V. Peroral direct cholangioscopic-guided selective intrahepatic duct stent placement with an ultraslim endoscope. Gastrointest Endosc 2010; 71: 875-878
• 8 Wright H, Sharma S, Gurakar A. et al. Management of biliary stricture guided by the Spyglass Direct Visualization System in a liver transplant recipient: an innovative approach. Gastrointest Endosc 2008; 67: 1201-1203
• 9 Kumar S. Cholangioscopy-directed endoscopic intervention for post-liver transplantation anastomotic biliary stricture. Gastrointest Endosc 2015; 81: 1014-1015
• 10 Woo YS, Lee JK, Noh DH. et al. SpyGlass cholangioscopy-assisted guidewire placement for post-LDLT biliary strictures: a case series. Surgical Endoscopy 2016; 30: 3897-3903
• 11 Shin JU, Lee JK, Kim KM. et al. Endoscopic naso-gallbladder drainage by using cholangioscopy for acute cholecystitis combined with cholangitis or choledocholithiasis (with video). Gastrointest Endosc 2012; 76: 1052-1055
• 12 Efthymiou M, Raftopoulos S, Antonio Chirinos J. et al. Air embolism complicated by left hemiparesis after direct cholangioscopy with an intraductal balloon anchoring system. Gastrointest Endosc 2012; 75: 221-223