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. 2018 Feb;87(2):584-589.e1.
doi: 10.1016/j.gie.2017.07.042. Epub 2017 Aug 7.

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

Monique T Barakat  1 , Mohit Girotra  1 , Abhishek Choudhary  1 , Robert J Huang  1 , Saurabh Sethi  1 , Subhas Banerjee  1
Affiliations

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

Monique T Barakat et al. Gastrointest Endosc. 2018 Feb.

Abstract

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

Methods: Patients underwent fluoroscopy-free biliary cannulation, sphincterotomy, and then cholangioscopy to establish location and number/size of stones and to 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 electrohydraulic 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 noncomplex choledocholithiasis with success and adverse event rates similar to standard ERCP. DSC represents a significant procedural advance in the management of biliary disorders that does not need to be confined to the fluoroscopy suite and can be reimagined as bedside procedures in emergency department or intensive care unit settings. (Clinical trial registration number: NCT03074201.).

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Conflict of interest statement

Disclosures: S.B. is a consultant for Boston Scientific. None of the other authors have any conflicts of interest pertaining to the study to disclose.

Figures

Figure 1
Figure 1
Flow diagram for patients presenting with choledocholithiasis over the 18-month period of study enrollment.
Figure 2
Figure 2
Depiction and description of key procedural steps in the performance of direct solitary cholangioscopy.
See this image and copyright information in PMC

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