Endoscopy 2019; 51(04): S15
DOI: 10.1055/s-0039-1681212
ESGE Days 2019 oral presentations
Friday, April 5, 2019 08:30 – 10:30: ERCP stones Club H
Georg Thieme Verlag KG Stuttgart · New York

EVALUATING DIGITAL SINGLE-OPERATOR-CHOLANGIOSCOPY FOR THE TREATMENT OF DIFFICULT BILIARY STONES: A RETROSPECTIVE MULTICENTER TRIAL

A Bokemeyer
1   Department of Medicine B for Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
,
F Lenze
1   Department of Medicine B for Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
,
D Lang
2   Department of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
,
C Gerges
2   Department of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
,
D Bettenworth
1   Department of Medicine B for Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
,
H Schmidt
1   Department of Medicine B for Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
,
H Neuhaus
2   Department of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
,
H Ullerich
1   Department of Medicine B for Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
,
T Beyna
2   Department of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

In patients with difficult biliary stones, standard endoscopic treatment might fail and recently introduced digital single-operator cholangioscopes (SOCs), equipped with an improved imaging quality, might be used as a rescue treatment approach.

Methods:

In two tertiary referral centers in Germany, a total of 422 digital SOC procedures performed between 2015 and 2018 were retrospectively analyzed. The examinations were performed due to a previous or expected failure of standard endoscopic techniques to treat biliary stones and only cases with a SOC-based biliary stone treatment using electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL) were included.

Results:

Overall, 76 examinations with a digital SOC-assisted biliary stone treatment, performed in 61 patients, were identified. Biliary stones were mainly extrahepatic (64.5%) and less frequently intrahepatic localized (35.5%) and the median stone size was 20 mm. Complete stone removal was achieved in 67.1% of cholangioscopies, while an incomplete removal was accomplished in 32.9% of examinations. Per SOC procedure, LL and EHL were similarly effective to achieve a complete stone removal (p = 0.90). Finally, the digital SOC-based treatment of biliary stone disease was successful in 97% of all patients; however, 13% of the patients needed at least two SOC-examinations for treatment.

Major complications, defined as postinterventional cholangitis and pancreatitis, occurred in 15.8% of cases. All cases of SOC-related complications had a mild clinical course and no mortalities occurred due to procedure related complications.

Conclusions:

Digital SOC-assisted biliary stone treatment is highly effective in patients with difficult biliary stone disease and should be considered the new standard of care for these patients; however, despite high treatment success rates, physicians should monitor these patients after performed procedures due to the significant rate of adverse events.