Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2021; 9(3): 736-747
Published online Jan 26, 2021. doi: 10.12998/wjcc.v9.i3.736
Cystic duct dilation through endoscopic retrograde cholangiopancreatography for treatment of gallstones and choledocholithiasis: Six case reports and review of literature
Yong-Gang He, Ming-Fa Gao, Jing Li, Xue-Hui Peng, Yi-Chen Tang, Xiao-Bing Huang, Yu-Ming Li
Yong-Gang He, Jing Li, Xue-Hui Peng, Yi-Chen Tang, Xiao-Bing Huang, Yu-Ming Li, Department of Hepatobiliary, The Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
Ming-Fa Gao, Department of Hepatobiliary, North-Kuanren General Hospital, Chongqing 401121, China
Author contributions: He YG, Gao MF, Huang XB and Li J contributed to conception and design of the study and drafted the manuscript; Peng XH and Tang YC contributed to analysis and interpretation of data and revised the manuscript; Li YM participated in clinical treatment operation and literature research; All authors read and approved the final manuscript.
Supported by Hospital Research Fund (General Project) from The Second Affiliated Hospital of Army Medical University, No. 2016YLC18 and No. 2019XLC2006.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xiao-Bing Huang, MD, Full Professor, Department of Hepatobiliary, The Second Affiliated Hospital, Army Medical University, No. 183 Xinqiao High Street, Shapingba District, Chongqing 400037, China. 13372618116@163.com
Received: October 15, 2020
Peer-review started: October 15, 2020
First decision: October 27, 2020
Revised: November 11, 2020
Accepted: November 29, 2020
Article in press: November 29, 2020
Published online: January 26, 2021
Processing time: 97 Days and 9.4 Hours
Abstract
BACKGROUND

Choledocholithiasis removal via endoscopic retrograde cholangiopancreatography (ERCP) then followed by laparoscopic cholecystectomy (LC) has gradually become the principal method in the treatment of gallstones and choledocholithiasis. We use ERCP through the cystic duct to treat gallstones combined with choledocholithiasis, with the aim to preserve the normal function of the gallbladder while simultaneously decreasing risk of biliary tract injury.

CASE SUMMARY

A total of six cases of patients diagnosed with gallstones and choledocholithiasis were treated with ERCP. The efficacy was evaluated via operation success rate, calculus removal rate, postoperative hospital stay and average hospitalization costs; the safety was evaluated through perioperative complication probability, gallbladder function detection and gallstones recrudesce. The calculus removal rate reached 100%, and patients had mild adverse events, including 1 case of postoperative acute cholecystitis and another of increased blood urinary amylase; both were relieved after corresponding treatment, the remaining cases had no complications. The average hospital stay and hospitalization costs were 6.16 ± 1.47 d and 5194 ± 696 dollars. The 3-11 mo follow-up revealed that gallbladder contracted well, without recurrence of gallstones.

CONCLUSION

This is the first batch of case reports for the treatment of gallstones and choledocholithiasis through ERCP approached by natural cavity. The results and effects of six reported cases proved that the new strategy is safe and feasible and is worthy of further exploration and application.

Keywords: Common bile duct; Choledocholithiasis; Duct of gallbladder; Gallstone; Endoscopic retrograde cholangiopancreatography; Case report

Core Tip: Radical treatment for gallbladder stones and choledocholithiasis through natural cavity endoscopy is one of the technical innovation surgeons have worked hard to explore. We report six cases of gallbladder stones combined with choledocholithiasis treated with endoscopic retrograde cholangiopancreatography through the cystic duct. The stones were completely removed, and the 11 mo follow-up showed gallbladder function remains intact. This strategy successfully decreased risk for secondary operations and cholecystectomy, was minimally invasive, preserved the integrity of gallbladder and common bile duct and should be regarded as a true natural orifice transluminal endoscopic surgery operation.