Surgical Endoscopy

, Volume 32, Issue 6, pp 2704–2712 | Cite as

Uncomplicated common bile duct stone removal guided by cholangioscopy versus conventional endoscopic retrograde cholangiopancreatography

  • Wiriyaporn Ridtitid
  • Thanawat Luangsukrerk
  • Phonthep Angsuwatcharakon
  • Panida Piyachaturawat
  • Prapimphan Aumpansub
  • Cameron Hurst
  • Roongruedee Chaiteerakij
  • Pradermchai Kongkam
  • Rungsun Rerknimitr



Although previous studies have reported the possibility of therapeutic ERCP without fluoroscopy, more robust documentation of fluoroscopy-free common bile duct stone (CBDS) clearance is needed. Technically, “digital cholangioscopy” (DCS) may be used to confirm CBDS clearance. We aimed to compare the feasibility, safety, and radiation exposure between patients with CBDS undergoing stone removal by DCS and conventional ERCP (cERCP).


Fifty (50) consecutive patients with a CBDS size < 15 mm underwent DCS (SpyGlass DS Direct Visualization System, Boston Scientific, Marlboro, MA, USA) between December 2015 and October 2016. Of 202 consecutive patients undergoing cERCP during the same time frame, 50 matched pairs were created using propensity score matching analysis. In the DCS group, patients underwent biliary cannulation and CBDS removal without fluoroscopy followed by DCS to confirm complete CBDS clearance. A final occlusion cholangiogram was performed as the current standard of care to confirm CBDS clearance.


Cannulation success rates were similar between the DCS and cERCP groups (98 vs. 98%). By intention-to-treat analysis, CBDS clearance in the DCS and cERCP groups was not different (90 vs. 98%; p = 0.20, respectively). DCS had successful CBDS removal in 45 cases, whereas 5 (10%) failed for clearance by DCS due to technical limitations. Adverse events were not different between both groups.


In the management of uncomplicated CBDS, our data confirmed the feasibility of DCS for CBDS clearance as it showed efficacy and safety comparable to those of cERCP. Although certain conditions may limit its effectiveness, DCS offers the ability to perform CBDS clearance without the need for fluoroscopy unit and can avoid radiation exposure while ERCP under fluoroscopy remains the current standard of care in patients with CBDS.


Endoscopic retrograde cholangiopancreatography Cholangioscopy Non-radiation Fluoroscopy 



Endoscopic retrograde cholangiopancreatography


Common bile duct stone


Endoscopic ultrasound


Intraductal ultrasound


Digital cholangioscopy


conventional ERCP


Dose area product


Transabdominal ultrasonography


Computed tomography


Magnetic resonance cholangiopancreatography


Standard deviation


American Society for Gastrointestinal Endoscopy


Compliance with ethical standards


Wiriyaporn Ridtitid, Thanawat Luangsukrerk, Phonthep Angsuwatcharakon, Panida Piyachaturawat, Prapimphan Aumpansub, Cameron Hurst, Roongruedee Chaiteerakij, Pradermchai Kongkam, and Rungsun Rerknimitr have no conflict of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Wiriyaporn Ridtitid
    • 1
  • Thanawat Luangsukrerk
    • 1
  • Phonthep Angsuwatcharakon
    • 2
  • Panida Piyachaturawat
    • 1
  • Prapimphan Aumpansub
    • 1
  • Cameron Hurst
    • 1
  • Roongruedee Chaiteerakij
    • 1
  • Pradermchai Kongkam
    • 1
  • Rungsun Rerknimitr
    • 1
    • 3
  1. 1.Department of Medicine, Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross SocietyBangkokThailand
  2. 2.Department of Anatomy, Faculty of MedicineChulalongkorn UniversityBangkokThailand
  3. 3.Division of Gastroenterology, Department of Medicine, Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalBangkokThailand

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