Gonçalo Alexandrino1, Luís Lopes2,3,4, João Fernandes2,5, Marta Moreira2, Tarcísio Araújo2, Sara Campos5, Rui Loureiro6, Luísa Figueiredo1, Luís Carvalho Lourenço1, David Horta1, Tiago Bana E Costa7, Patrício Costa3,4, Jorge Canena8,9,10,11. 1. Gastroenterology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal. 2. Gastroenterology Department, Hospital de Santa Luzia, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal. 3. School of Medicine, Life and Health Sciences Research Institute (ICVS), Universidade do Minho, Braga, Portugal. 4. ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal. 5. Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal. 6. Gastroenterology Department, Hospital Beatriz Ângelo, Loures, Portugal. 7. Gastroenterology Department, Hospital Egas Moniz - Centro Hospital Lisboa Ocidental, Lisbon, Portugal. 8. Gastroenterology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal. jmtcanena@live.com.pt. 9. Gastroenterology University Center - Hospital Cuf Tejo, Lisbon, Portugal. jmtcanena@live.com.pt. 10. Gastroenterology Department - Nova Medical School, Faculty of Medical Sciences, Hospital Cuf Tejo, Avenida 24 de Julho, 171A, 1350-352, Lisbon, Portugal. jmtcanena@live.com.pt. 11. Cintesis - Center for Health Technology and Services Research, Porto, Portugal. jmtcanena@live.com.pt.
Abstract
BACKGROUND: Peroral cholangioscopy (POC)-guided lithotripsy is an effective treatment for difficult biliary stones. A clear definition of factors associated with the efficacy of POC-guided lithotripsy in one session and the performance of electrohydraulic lithotripsy (EHL) and laser lithotripsy (LL) have not clearly emerged. METHODS: This was a non-randomized prospective multicenter study of all consecutive patients who underwent POC lithotripsy (using EHL and/or LL) for difficult biliary stones. The primary endpoint of the study was the number of sessions needed to achieve complete ductal clearance and the factors associated with this outcome. Secondary endpoints included the evaluated efficacies of LL and EHL. RESULTS: Ninety-four patients underwent 113 procedures of EHL or LL. Complete ductal clearance was obtained in 93/94 patients (98.94%). In total, 80/94 patients (85.11%) achieved stone clearance in a single session. In the multivariate analysis, stone size was independently associated with the need for multiple sessions to achieve complete ductal clearance (odds ratio = 1.146, 95% confidence interval: 1.055-1.244; p = 0.001). Using ROC curves and the Youden index, 22 mm was found to be the optimal cutoff for stone size (95% confidence interval: 15.71-28.28; p < 0.001). The majority of the patients (62.8%) underwent LL in the first session. Six patients failed the first session with EHL after using two probes and therefore were crossed over to LL, obtaining ductal clearance in a single additional session with a single LL fiber. EHL was significantly associated with a larger number of probes (2.0 vs. 1.02) to achieve ductal clearance (p < 0.01). The mean procedural time was significantly longer for EHL than for LL [72.1 (SD 16.3 min) versus 51.1 (SD 10.5 min)] (p < 0.01). CONCLUSIONS: POC is highly effective for difficult biliary stones. Most patients achieved complete ductal clearance in one session, which was significantly more likely for stones < 22 mm. EHL was significantly associated with the need for more probes and a longer procedural time to achieve ductal clearance.
BACKGROUND: Peroral cholangioscopy (POC)-guided lithotripsy is an effective treatment for difficult biliary stones. A clear definition of factors associated with the efficacy of POC-guided lithotripsy in one session and the performance of electrohydraulic lithotripsy (EHL) and laser lithotripsy (LL) have not clearly emerged. METHODS: This was a non-randomized prospective multicenter study of all consecutive patients who underwent POC lithotripsy (using EHL and/or LL) for difficult biliary stones. The primary endpoint of the study was the number of sessions needed to achieve complete ductal clearance and the factors associated with this outcome. Secondary endpoints included the evaluated efficacies of LL and EHL. RESULTS: Ninety-four patients underwent 113 procedures of EHL or LL. Complete ductal clearance was obtained in 93/94 patients (98.94%). In total, 80/94 patients (85.11%) achieved stone clearance in a single session. In the multivariate analysis, stone size was independently associated with the need for multiple sessions to achieve complete ductal clearance (odds ratio = 1.146, 95% confidence interval: 1.055-1.244; p = 0.001). Using ROC curves and the Youden index, 22 mm was found to be the optimal cutoff for stone size (95% confidence interval: 15.71-28.28; p < 0.001). The majority of the patients (62.8%) underwent LL in the first session. Six patients failed the first session with EHL after using two probes and therefore were crossed over to LL, obtaining ductal clearance in a single additional session with a single LL fiber. EHL was significantly associated with a larger number of probes (2.0 vs. 1.02) to achieve ductal clearance (p < 0.01). The mean procedural time was significantly longer for EHL than for LL [72.1 (SD 16.3 min) versus 51.1 (SD 10.5 min)] (p < 0.01). CONCLUSIONS: POC is highly effective for difficult biliary stones. Most patients achieved complete ductal clearance in one session, which was significantly more likely for stones < 22 mm. EHL was significantly associated with the need for more probes and a longer procedural time to achieve ductal clearance.
Authors: 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; Christopher J DiMaio; Sammy Ho; Bret Petersen; Jong Ho Moon; B Joseph Elmunzer; George J M Webster; Yen-I Chen; Laura K Dwyer; Summant Inamdar; Vanessa B Patrick; Augustin Attwell; Amy Hosmer; Christopher Ko; Attilio Maurano; Avik Sarkar; Linda J Taylor; Martin H Gregory; Daniel S Strand; Ali Raza; Shivangi Kothari; Jessica P Harris; Nikhil A Kumta; Amar Manvar; Mark D Topazian; Yun Nah Lee; Clayton M Spiceland; Arvind J Trindade; Majidah A Bukhari; Omid Sanaei; Saowanee Ngamruengphong; Mouen A Khashab Journal: Clin Gastroenterol Hepatol Date: 2017-10-24 Impact factor: 11.382
Authors: Anna Krigel; Snow Trinh T Nguyen; Nawar Talukder; Ching-Ho Huang; Carlos Buitrago; Gabriel Karkenny; Benjamin Lebwohl; Julian A Abrams; James L Araujo Journal: Dig Dis Sci Date: 2022-01-13 Impact factor: 3.487