Endoscopic clearance of non‐complex biliary stones using fluoroscopy‐free direct solitary cholangioscopy: Initial multicenter experience
Abstract Background and Aims Fluoroscopy‐free endoscopic retrograde cholangiopancreatography for common bile duct stone (CBDS) clearance is usually offered only to pregnant patients. We initiated a multicenter, randomized controlled trial comparing clearance of non‐complex CBDSs using fluoroscopy‐fr...
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Wiley
2024-04-01
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| Online Access: | https://doi.org/10.1002/deo2.241 |
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| author | Wiriyaporn Ridtitid Rungsun Rerknimitr Mohan Ramchandani Sundeep Lakhtakia Raj J Shah Janak N Shah Nirav Thosani Mahesh K Goenka Guido Costamagna Mihir S Wagh Vincenzo Perri Joyce Peetermans Pooja G Goswamy Zoe Liu Srey Yin Subhas Banerjee |
| author_facet | Wiriyaporn Ridtitid Rungsun Rerknimitr Mohan Ramchandani Sundeep Lakhtakia Raj J Shah Janak N Shah Nirav Thosani Mahesh K Goenka Guido Costamagna Mihir S Wagh Vincenzo Perri Joyce Peetermans Pooja G Goswamy Zoe Liu Srey Yin Subhas Banerjee |
| author_sort | Wiriyaporn Ridtitid |
| collection | DOAJ |
| description | Abstract Background and Aims Fluoroscopy‐free endoscopic retrograde cholangiopancreatography for common bile duct stone (CBDS) clearance is usually offered only to pregnant patients. We initiated a multicenter, randomized controlled trial comparing clearance of non‐complex CBDSs using fluoroscopy‐free direct solitary cholangioscopy (DSC) to standard endoscopic retrograde cholangiography (ERC) to evaluate the wider applicability of the DSC‐based approach. Here we report the initial results of stone clearance and safety in roll‐in cases for the randomized controlled trial. Methods Twelve expert endoscopists at tertiary care centers in four countries prospectively enrolled 47 patients with non‐complex CBDSs for DSC‐assisted CBDS removal in an index procedure including fluoroscopy‐free cannulation. Successful CBDS clearance was first determined by DSC and subsequently validated by final occlusion cholangiogram as the ERC gold standard. Results Fully fluoroscopy‐free cannulation was successful in 42/47 (89.4%) patients. Brief fluoroscopy with minimal contrast injection was used in 4/47 (8.5%) patients during cannulation. Cannulation failed in 1/47 (2.1%) patients. Fluoroscopy‐free complete stone clearance was reached in 38/46 (82.6%) cases. Residual stones were detected in the validation ERC occlusion cholangiogram in three cases. Overall serious adverse event rate was 2.1% (95% confidence interval 0.1–11.3): postprocedural pancreatitis in one patient. Conclusions In patients with non‐complex CBDS, the fluoroscopy‐free technique is easily transferred to endoscopic retrograde cholangiopancreatography experts with acceptable rates of cannulation and stone clearance and few serious adverse events. (ClinicalTrials.gov number, NCT03421340) |
| format | Article |
| id | doaj-art-74db6ebd2fcb4b8a903c4cc86339cc59 |
| institution | DOAJ |
| issn | 2692-4609 |
| language | English |
| publishDate | 2024-04-01 |
| publisher | Wiley |
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| spelling | doaj-art-74db6ebd2fcb4b8a903c4cc86339cc592025-08-20T02:55:03ZengWileyDEN Open2692-46092024-04-0141n/an/a10.1002/deo2.241Endoscopic clearance of non‐complex biliary stones using fluoroscopy‐free direct solitary cholangioscopy: Initial multicenter experienceWiriyaporn Ridtitid0Rungsun Rerknimitr1Mohan Ramchandani2Sundeep Lakhtakia3Raj J Shah4Janak N Shah5Nirav Thosani6Mahesh K Goenka7Guido Costamagna8Mihir S Wagh9Vincenzo Perri10Joyce Peetermans11Pooja G Goswamy12Zoe Liu13Srey Yin14Subhas Banerjee15Department of Medicine, Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital Thai Red Cross Society Bangkok ThailandDepartment of Medicine, Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital Thai Red Cross Society Bangkok ThailandAsian Institute of Gastroenterology Hyderabad IndiaAsian Institute of Gastroenterology Hyderabad IndiaDivision of Gastroenterology and Hepatology University of Colorado Hospital Aurora USADivision of Gastroenterology Ochsner Clinic Foundation New Orleans USAErtan Digestive Disease Center‐Texas Medical Center Houston USAInstitute of Gastrosciences and Liver Apollo Multispeciality Hospitals Kolkata IndiaDigestive Endoscopy Unit Department of Translational Medicine and Surgery Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome ItalyDivision of Gastroenterology and Hepatology University of Colorado Hospital Aurora USADigestive Endoscopy Unit Department of Translational Medicine and Surgery Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome ItalyBoston Scientific Corporation Marlborough USABoston Scientific Corporation Marlborough USABoston Scientific Corporation Marlborough USABoston Scientific Corporation Marlborough USADivision of Gastroenterology and Hepatology Stanford University Stanford USAAbstract Background and Aims Fluoroscopy‐free endoscopic retrograde cholangiopancreatography for common bile duct stone (CBDS) clearance is usually offered only to pregnant patients. We initiated a multicenter, randomized controlled trial comparing clearance of non‐complex CBDSs using fluoroscopy‐free direct solitary cholangioscopy (DSC) to standard endoscopic retrograde cholangiography (ERC) to evaluate the wider applicability of the DSC‐based approach. Here we report the initial results of stone clearance and safety in roll‐in cases for the randomized controlled trial. Methods Twelve expert endoscopists at tertiary care centers in four countries prospectively enrolled 47 patients with non‐complex CBDSs for DSC‐assisted CBDS removal in an index procedure including fluoroscopy‐free cannulation. Successful CBDS clearance was first determined by DSC and subsequently validated by final occlusion cholangiogram as the ERC gold standard. Results Fully fluoroscopy‐free cannulation was successful in 42/47 (89.4%) patients. Brief fluoroscopy with minimal contrast injection was used in 4/47 (8.5%) patients during cannulation. Cannulation failed in 1/47 (2.1%) patients. Fluoroscopy‐free complete stone clearance was reached in 38/46 (82.6%) cases. Residual stones were detected in the validation ERC occlusion cholangiogram in three cases. Overall serious adverse event rate was 2.1% (95% confidence interval 0.1–11.3): postprocedural pancreatitis in one patient. Conclusions In patients with non‐complex CBDS, the fluoroscopy‐free technique is easily transferred to endoscopic retrograde cholangiopancreatography experts with acceptable rates of cannulation and stone clearance and few serious adverse events. (ClinicalTrials.gov number, NCT03421340)https://doi.org/10.1002/deo2.241bile duct stonecholangioscopyendoscopic retrograde cholangiographyfluoroscopy‐freegastrointestinal endoscopy |
| spellingShingle | Wiriyaporn Ridtitid Rungsun Rerknimitr Mohan Ramchandani Sundeep Lakhtakia Raj J Shah Janak N Shah Nirav Thosani Mahesh K Goenka Guido Costamagna Mihir S Wagh Vincenzo Perri Joyce Peetermans Pooja G Goswamy Zoe Liu Srey Yin Subhas Banerjee Endoscopic clearance of non‐complex biliary stones using fluoroscopy‐free direct solitary cholangioscopy: Initial multicenter experience DEN Open bile duct stone cholangioscopy endoscopic retrograde cholangiography fluoroscopy‐free gastrointestinal endoscopy |
| title | Endoscopic clearance of non‐complex biliary stones using fluoroscopy‐free direct solitary cholangioscopy: Initial multicenter experience |
| title_full | Endoscopic clearance of non‐complex biliary stones using fluoroscopy‐free direct solitary cholangioscopy: Initial multicenter experience |
| title_fullStr | Endoscopic clearance of non‐complex biliary stones using fluoroscopy‐free direct solitary cholangioscopy: Initial multicenter experience |
| title_full_unstemmed | Endoscopic clearance of non‐complex biliary stones using fluoroscopy‐free direct solitary cholangioscopy: Initial multicenter experience |
| title_short | Endoscopic clearance of non‐complex biliary stones using fluoroscopy‐free direct solitary cholangioscopy: Initial multicenter experience |
| title_sort | endoscopic clearance of non complex biliary stones using fluoroscopy free direct solitary cholangioscopy initial multicenter experience |
| topic | bile duct stone cholangioscopy endoscopic retrograde cholangiography fluoroscopy‐free gastrointestinal endoscopy |
| url | https://doi.org/10.1002/deo2.241 |
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