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Keywords = electrohydraulic lithotripsy

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21 pages, 3856 KiB  
Review
Endoscopic Management of Benign Pancreaticobiliary Disorders
by Amar Vedamurthy, Rajesh Krishnamoorthi, Shayan Irani and Richard Kozarek
J. Clin. Med. 2025, 14(2), 494; https://doi.org/10.3390/jcm14020494 - 14 Jan 2025
Cited by 1 | Viewed by 1964
Abstract
Endoscopic management of benign pancreaticobiliary disorders encompasses a range of procedures designed to address complications in gallstone disease, choledocholithiasis, and pancreatic disorders. Acute cholecystitis is typically treated with cholecystectomy or percutaneous drainage (PT-GBD), but for high-risk or future surgical candidates, alternative decompression methods, [...] Read more.
Endoscopic management of benign pancreaticobiliary disorders encompasses a range of procedures designed to address complications in gallstone disease, choledocholithiasis, and pancreatic disorders. Acute cholecystitis is typically treated with cholecystectomy or percutaneous drainage (PT-GBD), but for high-risk or future surgical candidates, alternative decompression methods, such as endoscopic transpapillary gallbladder drainage (ETP-GBD), and endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD), are effective. PT-GBD is associated with significant discomfort as well as variable adverse event rates. EUS-GBD leverages lumen-apposing metal stents (LAMS) for direct access to the gallbladder, providing the ability to treat an inflamed GB internally. Choledocholithiasis is primarily managed with ERCP, utilizing techniques to include balloon extraction, mechanical lithotripsy, or advanced methods such as electrohydraulic or laser lithotripsy in cases of complex stones. Altered anatomy from bariatric procedures like Roux-en-Y gastric bypass may necessitate specialized approaches, including balloon-assisted ERCP or EUS-directed transgastric ERCP (EDGE). Post-operative complications, including bile leaks and strictures, are managed endoscopically using sphincterotomy and stenting. Post-liver transplant anastomotic and non-anastomotic strictures often require repeated stent placements or advanced techniques like magnetic compression anastomosis in refractory cases. In chronic pancreatitis (CP), endoscopic approaches aim to relieve pain and address structural complications like pancreatic duct (PD) strictures and calculi. ERCP with sphincterotomy and stenting, along with extracorporeal shock wave lithotripsy (ESWL), achieves effective ductal clearance for PD stones. When traditional approaches are insufficient, direct visualization with peroral pancreatoscopy-assisted lithotripsy is utilized. EUS-guided interventions, such as cystgastrostomy, pancreaticogastrostomy, and celiac plexus blockade, offer alternative therapeutic options for pain management and drainage of peripancreatic fluid collections. EUS plays a diagnostic and therapeutic role in CP, with procedures tailored for high-risk patients or those with complex anatomy. As techniques evolve, endoscopic management provides minimally invasive alternatives for patients with complex benign pancreaticobiliary conditions, offering high clinical success and fewer complications. Full article
(This article belongs to the Special Issue Advances in Diagnosis and Management of Pancreatobiliary Disorders)
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18 pages, 1623 KiB  
Review
Endoscopic Management of Difficult Biliary Stones: An Evergreen Issue
by Magdalini Manti, Jimil Shah, Apostolis Papaefthymiou, Antonio Facciorusso, Daryl Ramai, Georgios Tziatzios, Vasilios Papadopoulos, Konstantina Paraskeva, Ioannis S. Papanikolaou, Konstantinos Triantafyllou, Marianna Arvanitakis, Livia Archibugi, Giuseppe Vanella, Marcus Hollenbach and Paraskevas Gkolfakis
Medicina 2024, 60(2), 340; https://doi.org/10.3390/medicina60020340 - 19 Feb 2024
Cited by 7 | Viewed by 4431
Abstract
Choledocholithiasis is one of the most common indications for endoscopic retrograde cholangiopancreatography (ERCP) in daily practice. Although the majority of stones are small and can be easily removed in a single endoscopy session, approximately 10–15% of patients have complex biliary stones, requiring additional [...] Read more.
Choledocholithiasis is one of the most common indications for endoscopic retrograde cholangiopancreatography (ERCP) in daily practice. Although the majority of stones are small and can be easily removed in a single endoscopy session, approximately 10–15% of patients have complex biliary stones, requiring additional procedures for an optimum clinical outcome. A plethora of endoscopic methods is available for the removal of difficult biliary stones, including papillary large balloon dilation, mechanical lithotripsy, and electrohydraulic and laser lithotripsy. In-depth knowledge of these techniques and the emerging literature on them is required to yield the most optimal therapeutic effects. This narrative review aims to describe the definition of difficult bile duct stones based on certain characteristics and streamline their endoscopic retrieval using various modalities to achieve higher clearance rates. Full article
(This article belongs to the Special Issue Latest Advances in Pancreatobiliary Endoscopy)
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9 pages, 662 KiB  
Article
Efficacy and Safety of Electrohydraulic Lithotripsy Using Peroral Cholangioscopy under Endoscopic Retrograde Cholangiopancreatography Guidance in Older Adults: A Single-Center Retrospective Study
by Koji Takahashi, Hiroshi Ohyama, Yuichi Takiguchi, Yu Sekine, Shodai Toyama, Nana Yamada, Chihei Sugihara, Motoyasu Kan, Mayu Ouchi, Hiroki Nagashima, Yotaro Iino, Yuko Kusakabe, Kohichiroh Okitsu, Izumi Ohno and Naoya Kato
Medicina 2023, 59(4), 795; https://doi.org/10.3390/medicina59040795 - 19 Apr 2023
Cited by 3 | Viewed by 3482
Abstract
Background and objectives: The safety of electrohydraulic lithotripsy (EHL) in older adults remains unclear. We aimed to investigate the efficacy and safety of EHL using peroral cholangioscopy (POCS) under endoscopic retrograde cholangiopancreatography (ERCP) guidance in older adults aged ≥80 years. Materials and Methods: [...] Read more.
Background and objectives: The safety of electrohydraulic lithotripsy (EHL) in older adults remains unclear. We aimed to investigate the efficacy and safety of EHL using peroral cholangioscopy (POCS) under endoscopic retrograde cholangiopancreatography (ERCP) guidance in older adults aged ≥80 years. Materials and Methods: This retrospective clinical study was conducted at a single center. Fifty patients with common bile duct stones who underwent EHL using POCS under ERCP guidance at our institution, between April 2017 and September 2022, were enrolled in this study. The eligible patients were divided into an elderly group (n = 21, age ≥80 years) and a non-elderly group (n = 29, age ≤79 years), and were analyzed. Results: A total of 33 and 40 EHL procedures were performed in the elderly and non-elderly groups, respectively. After excluding cases in which stone removal was performed at other institutions, complete removal of common bile duct stones was confirmed in 93.8% and 100% of the elderly and non-elderly groups, respectively (p = 0.20). The mean number of ERCPs required for complete removal of bile duct stones was 2.9 and 4.3 in the elderly and non-elderly groups, respectively (p = 0.17). In the EHL session, the overall occurrence of adverse events was eight and seven in the elderly (24.2%) and non-elderly (17.5%) groups, respectively; however, the difference was insignificant (p = 0.48). Conclusions: EHL using POCS under ERCP guidance is effective in patients aged ≥80 years and there was no significant increase in adverse event rates compared to those aged ≤79 years. Full article
(This article belongs to the Special Issue Digestive Endoscopy: Inside the Evidence and Outside)
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8 pages, 1577 KiB  
Article
The Usefulness of Peroral Cholangioscopy for Intrahepatic Stones
by Yuri Sakamoto, Yohei Takeda, Yuta Seki, Shiho Kawahara, Takuya Shimosaka, Wataru Hamamoto, Hiroki Koda, Taro Yamashita, Takumi Onoyama, Kazuya Matsumoto, Kazuo Yashima and Hajime Isomoto
J. Clin. Med. 2022, 11(21), 6425; https://doi.org/10.3390/jcm11216425 - 29 Oct 2022
Cited by 8 | Viewed by 2275
Abstract
Peroral cholangioscopy (POCS) is believed to be effective in treating intrahepatic stones; however, reports on its efficacy are few. We reviewed the results of intrahepatic stones treated with fluoroscopic guidance or POCS. This study included 26 patients who underwent endoscopic treatment for intrahepatic [...] Read more.
Peroral cholangioscopy (POCS) is believed to be effective in treating intrahepatic stones; however, reports on its efficacy are few. We reviewed the results of intrahepatic stones treated with fluoroscopic guidance or POCS. This study included 26 patients who underwent endoscopic treatment for intrahepatic stones at our institution between January 2017 and December 2021. We retrospectively evaluated the procedure time and adverse events in the first session and the rate of complete stone removal. Complete stone removal was achieved in 92% (24/26); POCS was required in 16 of 26 (62%) procedures and the complete stone removal was achieved in 15 of 16 (94%) of these procedures. The POCS group had a significantly longer procedure time than the fluoroscopy group. Cholangitis incidence was high; however, no difference was noted between patients with and without POCS, and all cases were mild and treated conservatively. Endoscopic treatment for intrahepatic stones may lead to an increase in the incidence of cholangitis, requires specialized devices such as a cholangioscope, and should be performed in an established institution by experienced staff. POCS is useful for intrahepatic stones formed upstream of the stenosis and intrahepatic stones piled in the bile duct. Full article
(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)
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17 pages, 6890 KiB  
Review
Difficult Biliary Stones: A Comprehensive Review of New and Old Lithotripsy Techniques
by Edoardo Troncone, Michelangela Mossa, Pasquale De Vico, Giovanni Monteleone and Giovanna Del Vecchio Blanco
Medicina 2022, 58(1), 120; https://doi.org/10.3390/medicina58010120 - 13 Jan 2022
Cited by 37 | Viewed by 9358
Abstract
Biliary stones represent the most common indication for therapeutic endoscopic retrograde cholangiopancreatography. Many cases are successfully managed with biliary sphincterotomy and stone extraction with balloon or basket catheters. However, more complex conditions secondary to the specific features of stones, the biliary tract, or [...] Read more.
Biliary stones represent the most common indication for therapeutic endoscopic retrograde cholangiopancreatography. Many cases are successfully managed with biliary sphincterotomy and stone extraction with balloon or basket catheters. However, more complex conditions secondary to the specific features of stones, the biliary tract, or patient’s needs could make the stone extraction with the standard techniques difficult. Traditionally, mechanical lithotripsy with baskets has been reported as a safe and effective technique to achieve stone clearance. More recently, the increasing use of endoscopic papillary large balloon dilation and the diffusion of single-operator cholangioscopy with laser or electrohydraulic lithotripsy have brought new, safe, and effective therapeutic possibilities to the management of such challenging cases. We here summarize the available evidence about the endoscopic management of difficult common bile duct stones and discuss current indications of different lithotripsy techniques. Full article
(This article belongs to the Special Issue Recent Advances in Biliopancreatic Endoscopy)
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6 pages, 13447 KiB  
Communication
Percutaneous Transhepatic Electrohydraulic Lithotripsy for the Treatment of Difficult Bile Stones
by Anna Maria Ierardi, Giovanni Maria Rodà, Letizia Di Meglio, Giuseppe Pellegrino, Paolo Cantù, Daniele Dondossola, Giorgio Rossi and Gianpaolo Carrafiello
J. Clin. Med. 2021, 10(7), 1372; https://doi.org/10.3390/jcm10071372 - 29 Mar 2021
Cited by 6 | Viewed by 3216
Abstract
Objectives: To evaluate the efficacy and safety of percutaneous transhepatic lithotripsy (PTL) using an electro-hydraulic (EH) system for difficult bile stones. Methods: We retrospectively evaluated two patients with recurrent cholangitis, jaundice and fever for the presence of difficult bile stones, inaccessible by an [...] Read more.
Objectives: To evaluate the efficacy and safety of percutaneous transhepatic lithotripsy (PTL) using an electro-hydraulic (EH) system for difficult bile stones. Methods: We retrospectively evaluated two patients with recurrent cholangitis, jaundice and fever for the presence of difficult bile stones, inaccessible by an endoscopic approach, treated with PTL. Both procedures were conducted using the same protocol, with two different accesses. The treatments were performed using a 10 Fr flexible choledoscopy SpyGlass DSTM for visualization and an EH system for lithotripsy. Results: Technical success, clinical success and complications were evaluated. The two procedures were successfully concluded in both patients without any residual stones in the biliary tree. For both patients, a short follow-up period of six months was available, during which they remained asymptomatic. Neither major nor minor complications were registered. Conclusion: PTL was determined to be an effective and safe technique. This procedure allows a direct visualization of the stone, reducing fluoroscopy time and permitting a less invasive and less traumatic method for the percutaneous management of difficult bile stones. Advances in knowledge: The direct visualization, the high quality of the digital view, the adequate length of the device and the less traumatic approach of EH systems represent advantages compared with other available technologies. Full article
(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)
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