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      A prospective evaluation of radiation-free direct solitary cholangioscopy for the management of choledocholithiasis

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          Abstract

          Background and Aims

          Endoscopy has replaced many radiological studies for the GI tract. However, ERCP remains a hybrid endoscopic-fluoroscopic procedure, which limits its portable delivery, creates delays due to fluoroscopy room unavailability and exposes patients/providers to radiation. We evaluated fluoroscopy/radiation-free management of patients with non-complex choledocholithiasis using direct solitary cholangioscopy (DSC).

          Methods

          Patients underwent fluoroscopy-free biliary cannulation, sphincterotomy then cholangioscopy to establish location, number/size of stones and document distance from ampulla to bifurcation to guide balloon advancement. Stones were extracted using a marked balloon catheter advanced to the bifurcation and inflated to the bile duct diameter, documented on prior imaging. Repeat cholangioscopy was performed to confirm stone clearance.

          Results

          Fluoroscopy-free biliary cannulation was successful in all 40 patients (100%). Advanced cannulation techniques were required in 5 patients. Papillary balloon dilation was performed in 8 patients and electro-hydraulic lithotripsy in 3 patients. Discrete stones were visualized in 31 patients and stone debris/sludge in 8 patients. Fluoroscopy-free stone/debris/sludge extraction was successful in all these patients. Brief fluoroscopy was used in 2 patients (5%) to confirm stone clearance. No stone/debris/sludge was noted in 1 patient. Mild pancreatitis was noted in 2 patients (5%) and bleeding in 1 (2.5%).

          Conclusions

          This study establishes the feasibility of fluoroscopy/radiation-free, cholangioscopic management of non-complex choledocholithiasis, with, success and adverse event rates similar to standard ERCP. DSC represents a significant procedural advance in the management of biliary disorders, which need not be confined to the fluoroscopy suite, and can be reimagined as bedside procedures in emergency department or intensive care unit settings.

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          Author and article information

          Journal
          0010505
          3842
          Gastrointest Endosc
          Gastrointest. Endosc.
          Gastrointestinal endoscopy
          0016-5107
          1097-6779
          10 August 2017
          07 August 2017
          February 2018
          01 February 2019
          : 87
          : 2
          : 584-589.e1
          Affiliations
          Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, United States
          Author notes
          Corresponding Author: Subhas Banerjee, MD, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC 5244, Stanford, CA 94305, sbanerje@ 123456stanford.edu , phone: 650-723-2623| fax: 650-725-0705
          Article
          PMC5801123 PMC5801123 5801123 nihpa898221
          10.1016/j.gie.2017.07.042
          5801123
          28797911
          cb398de0-dc8f-4bea-a237-ba680e50430f
          History
          Categories
          Article

          Choledocholithiasis,Cholangioscopy,ERCP,Radiation,Fluoroscopy

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