Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2023; 29(16): 2495-2501
Published online Apr 28, 2023. doi: 10.3748/wjg.v29.i16.2495
Cholangioscopy-assisted extraction through novel papillary support for small-calibre and sediment-like common bile duct stones
Wen-Gang Zhang, Ning-Li Chai, Bo Zhang, Xiao Li, Jia-Feng Wang, Hao Dong, Yu-Jie Feng, En-Qiang Linghu
Wen-Gang Zhang, Ning-Li Chai, Bo Zhang, Xiao Li, Jia-Feng Wang, Hao Dong, Yu-Jie Feng, En-Qiang Linghu, Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Zhang WG analyzed the data and wrote the manuscript; Zhang WG and Chai NL contributed equally for this study, and considered as co-first author; Linghu EQ and Chai NL performed the procedures; Zhang B, Li X, Wang JF, Dong H, and Feng YJ revised the manuscript.
Supported by National Key Research and Development Program of China, No. 2022YFC2503600.
Institutional review board statement: The study was carried out under the ethics committee approval from the Chinese PLA General Hospital (Beijing China).
Informed consent statement: Informed consent was obtained from all participating patients.
Conflict-of-interest statement: We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: En-Qiang Linghu, PhD, Chief Physician, Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. linghuenqiang@vip.sina.com
Received: February 2, 2023
Peer-review started: February 2, 2023
First decision: March 7, 2023
Revised: March 9, 2023
Accepted: April 7, 2023
Article in press: April 7, 2023
Published online: April 28, 2023
Processing time: 81 Days and 0.1 Hours
Abstract
BACKGROUND

To date, endoscopic retrograde cholangiopancreatography has become a well-established treatment for common bile duct (CBD) stones. However, it is not suitable for some special patients, such as pregnant women, children or those who cannot stop taking anti-coagulation/anti-platelet agents because of radiation injury and the risk of postoperative bleeding resulting from endoscopic sphincterotomy. To overcome these two problems, this study introduced cholangioscopy-assisted extraction through a novel papillary support for small-calibre and sediment-like CBD stones.

AIM

To assess the feasibility and safety of cholangioscopy-assisted extraction through a novel papillary support (CEPTS) for small-calibre and sediment-like common bile duct (CBD) stones.

METHODS

This Retrospective study was approved by the Ethics Committee of the Chinese PLA General Hospital. We designed a covered single dumbbell-style papillary support between 2021 and 2022. Between July 2022 and September 2022, 7 consecutive patients with small-calibre (cross diameter ≤ 1.0 cm) or sediment-like CBD stones underwent CETPS procedures in our center. The clinical characteristics and treatment outcomes of these 7 patients were extracted from a prospectively collected database. And the related data were analyzed. Informed consent was obtained from all participating patients.

RESULTS

A total of 2 patients had yellow sediment-like CBD stones, and aspiration extraction was performed after the insertion of papillary support. Of the 5 patients with clumpy CBD stones (0.4-1.0 cm), 2 underwent basket extraction under direct vision for a single stone (0.5-1.0 cm, black and black grey), 1 underwent balloon plus aspiration extraction under direct vision for 5 stones (0.4-0.6 cm, brown), and 2 underwent aspiration extraction only for a single stone (0.5-0.6 cm, yellow, none). Technical success, namely, no residual stones in the CBD or left and right hepatic ducts, was achieved in all 7 cases (100%). The median operating time was 45.0 minutes (range 13.0–87.0 minutes). Postoperative pancreatitis (PEP) occurred in one case (14.3%). Hyperamylasaemia without abdominal pain was noted in 2 of 7 patients. No residual stones or cholangitis were found during the follow-up.

CONCLUSION

CETPS appeared to be feasible to treat patients with small-calibre or sediment-like CBD stones. Patients, especially pregnant women and those who cannot stop anticoagulation/anti-platelet agents, could benefit from this technique.

Keywords: Cholangioscopy; Common bile duct stones; Papillary support

Core Tip: Endoscopic retrograde cholangiopancreatography (ERCP) has become a well-established treatment for common bile duct (CBD) stones. However, the standard ERCP technique always requires endoscopic sphincterotomy (EST), which might lead to the loss of sphincter of Oddi function and some adverse events, including bleeding and perforation. Moreover, radiation injury makes the standard ERCP technique unsuitable for special patients, such as pregnant women and children. To overcome these problems, the present study introduced cholangioscopy-assisted extraction through a novel papillary support for small-calibre and sediment-like CBD stones, reducing radiation injury and avoiding EST.