Effectiveness of peroral direct cholangioscopy using an ultraslim endoscope for the treatment of hepatolithiasis in patients with hepaticojejunostomy (with video)
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Hepatolithiasis is a postoperative complication of hepaticojejunostomy (HJ) performed for various pancreatobiliary diseases. Hepatolithiasis can cause repeated cholangitis. Complete stone removal and bile stasis elimination are therefore necessary. Here, we evaluated the effectiveness of peroral direct cholangioscopy (PDCS) using an ultraslim endoscope for treating hepatolithiasis in HJ patients.
We studied 14 patients with hepatolithiasis who underwent bowel reconstruction with HJ between April 2012 and May 2014. Diagnostic and therapeutic endoscopic retrograde cholangiography using a short double-balloon enteroscope (DBE) was initially performed. Following stone removal, the DBE was exchanged for an ultraslim endoscope through the balloon overtube for PDCS.
The success rate of PDCS procedure was 85.7 % (12/14). In 5 of 12 (41.7 %) patients with successful PDCS, the residual stones were detected and removed completely using a 5-Fr basket catheter and suction after normal saline irrigation. In the remaining 7 (58.3 %) patients, no residual stone was detected. The median procedure time was 14 min (range 8–36) with no serious postoperative complications. The median follow-up time after PDCS was 21 months (range 5–26), and only 1 patient (8.3 %) had IHBD stone recurrence with an anastomotic stricture.
PDCS using an ultraslim endoscope appears to be useful for detecting and removing residual stones following hepatolithiasis treatment using a DBE. The combined use of a DBE and PDCS may reduce the risk of hepatolithiasis recurrence in HJ patients.
KeywordsPeroral direct cholangioscopy Hepatolithiasis Altered gastrointestinal anatomy Short double-balloon enteroscopy
Kazuyuki Matsumoto, Koichiro Tsutsumi, Hironari Kato, Yutaka Akimoto, Daisuke Uchida, Takeshi Tomoda, Naoki Yamamoto, Yasuhiro Noma, Shigeru Horiguchi, Hiroyuki Okada and Kazuhide Yamamoto have no conflicts of interest to disclose.
The DBE was exchanged for an ultraslim endoscope leaving the overtube with its balloon inflated. The ultraslim endoscope was advanced through the balloon overtube up to the hepaticojejunostomy anastomosis and was directly inserted into the intrahepatic bile duct. Residual stones were detected and extracted using a 5-Fr basket catheter and suction after normal saline irrigation (WMV 7298 kb)
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