A case of complete removal of stacked common bile duct stones by peroral direct digital cholangioscopy in a patient with surgically altered anatomy

IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Noriyuki Hirakawa, Katsuya Kitamura, Takao Itoi
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引用次数: 0

Abstract

Treatment of common bile duct stones or anastomotic stenosis is challenging in patients with surgically altered anatomy (SAA). Although the clinical outcomes of balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) have been improving in these patients,1-3 stacked stones are still difficult to remove in some cases. There are also cases in which electrohydraulic lithotripsy (EHL) is required for the removal of stacked stones in patients with SAA.4

The patient in this case was an 89-year-old man who had undergone Roux-en Y reconstruction after resection of gastric cancer. He was admitted to our hospital for treatment of cholangitis due to stacked common bile duct stones. BE-ERCP was attempted for bile duct drainage, but the papilla could not be identified and percutaneous transhepatic biliary drainage was performed. Then rendezvous BE-ERCP using the percutaneous transhepatic drainage route was performed (Figure 1). Although the papilla could be identified, the stacked stones were difficult to remove, and EHL was planned for the next session. Unfortunately, a peroral direct digital cholangioscope (SpyDS; Boston Scientific, Natick, Massachusetts, USA) with a caliber of 3.3 mm was not available for BE-ERCP because of the limited diameter of the accessory channel (3.2 mm). Therefore, ERCP was performed using a colonoscope (CF-XZ1200; Olympus Medical, Tokyo, Japan), in which the cholangioscope can be inserted via the accessory channel (3.7 mm).

The cholangioscope was inserted into the common bile duct via the CF-XZ1200 and showed that the common bile duct was filled with stacked stones. The stacked stones were crushed by EHL and cholangiography showed that the stones were reduced in size. The stones were completely removed using a mechanical lithotripter and basket catheter. The patient had a favorable course and was discharged (Figure 2).

This case demonstrates that stacked stones can be safely and effectively removed by EHL and other tools with the CF-XZ1200 in a patient with SAA.

Conception and design: Noriyuki Hirakawa, Katsuya Kitamura and Takao Itoi. Manuscript preparation: Noriyuki Hirakawa. Endoscopic procedures: Noriyuki Hirakawa and Katsuya Kitamura.

Abstract Image

一例通过口腔直接数字胆管造影术彻底清除堆叠的胆总管结石的病例,患者因手术改变了解剖结构。
对于手术解剖结构改变(SAA)的患者来说,胆总管结石或吻合口狭窄的治疗具有挑战性。虽然球囊肠镜辅助内镜逆行胰胆管造影术(BE-ERCP)在这些患者中的临床疗效有所改善1-3,但在某些病例中,堆积的结石仍然难以取出。4 本病例中的患者是一名 89 岁的男性,在胃癌切除术后接受了 Roux-en Y 重建术。4 本病例中的患者是一位 89 岁的老人,他在胃癌切除术后接受了 Roux-en Y 整形手术,因胆总管叠层结石导致胆管炎而入院治疗。曾尝试采用BE-ERCP进行胆管引流,但无法确定乳头,于是进行了经皮经肝胆管引流。然后,使用经皮经肝引流途径进行了会合 BE-ERCP(图 1)。虽然可以确定乳头,但堆积的结石难以取出,因此计划在下一次治疗中进行 EHL。遗憾的是,由于附属通道直径有限(3.2 毫米),无法使用口径为 3.3 毫米的口周直接数字胆道镜(SpyDS;Boston Scientific,Natick,Massachusetts,USA)进行 BE-ERCP 手术。因此,ERCP 使用结肠镜(CF-XZ1200;奥林巴斯医疗公司,日本东京)进行,胆道镜可通过附属通道(3.7 毫米)插入。胆管造影显示结石体积缩小。使用机械碎石机和篮式导管彻底清除了结石。该病例表明,在 SAA 患者身上,使用 EHL 和其他工具以及 CF-XZ1200 可以安全有效地取出堆积结石:构思与设计:Noriyuki Hirakawa、Katsuya Kitamura 和 Takao Itoi。手稿准备: Noriyuki Hirakawa、Katsuya Kitamura 和 Takao Itoi:Noriyuki Hirakawa。内窥镜手术:内窥镜手术:Noriyuki Hirakawa 和 Katsuya Kitamura。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Hepato‐Biliary‐Pancreatic Sciences
Journal of Hepato‐Biliary‐Pancreatic Sciences GASTROENTEROLOGY & HEPATOLOGY-SURGERY
自引率
10.00%
发文量
178
审稿时长
6-12 weeks
期刊介绍: The Journal of Hepato-Biliary-Pancreatic Sciences (JHBPS) is the leading peer-reviewed journal in the field of hepato-biliary-pancreatic sciences. JHBPS publishes articles dealing with clinical research as well as translational research on all aspects of this field. Coverage includes Original Article, Review Article, Images of Interest, Rapid Communication and an announcement section. Letters to the Editor and comments on the journal’s policies or content are also included. JHBPS welcomes submissions from surgeons, physicians, endoscopists, radiologists, oncologists, and pathologists.
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