Per oral cholangiopancreatoscopy in pancreatico biliary diseases - Expert consensus statements

Table 5 Consensus statement 3

POCS and POCS-guided lithotripsy is recommended for treatment of difficult CBD stones when standard techniques fail

Recommendation Grade A

Quality of evidence: 1+

Technical success: Technical success for POCS and POCS-guided lithotripsy for the treatment of difficult CBD stones when standard techniques fail range from 71%-100%

Direct visualization advantage: One of the key therapeutic benefits of POCS is the capacity to directly visualize and treat large intraductal stones. Studies show that nearly all bile duct stones which failed conventional endoscopic removal (5%-10% of patients) could be removed non-surgically using POCS and POCS-guided lithotripsy

Residual stone detection: The diagnosis of small bile duct stones can be difficult with an ERCP. In those cases, POCS is able to detect residual stones missed on routine ERCP.

Complications: The most common complication reported is cholangitis (4.0%). Reported overall complications rates range from 3.8% to 13.3%

The results support the non-surgical management of difficult bile duct stones, particularly in patients at high risk for surgery

POCS: Peroral cholangioscopy; CBD: Common bile duct; ERCP: Endoscopic retrograde cholangiopancreatography.