Efficacy and Safety of Digital Single-Operator Cholangioscopy for Difficult Biliary Stones

Olaya I. Brewer Gutierrez, Noor L.H. Bekkali, Isaac Raijman, Richard Sturgess, Divyesh V. Sejpal, Hanaa D. Aridi, Stuart Sherman, Raj J. Shah, Richard S. Kwon, James L. Buxbaum, Claudio Zulli, Wahid Wassef, Douglas G. Adler, Vladimir Kushnir, Andrew Y. Wang, Kumar Krishnan, Vivek Kaul, Demetrios Tzimas, Christopher J. DiMaio, Sammy HoBret Petersen, Jong Ho Moon, B. Joseph Elmunzer, George J.M. Webster, Yen I. Chen, Laura K. Dwyer, Summant Inamdar, Vanessa B. Patrick, Augustin Attwell, Amy Hosmer, Christopher Ko, Attilio Maurano, Avik Sarkar, Linda J. Taylor, Martin H. Gregory, Daniel S. Strand, Ali Raza, Shivangi Kothari, Jessica P. Harris, Nikhil A. Kumta, Amar Manvar, Mark D. Topazian, Yun Nah Lee, Clayton M. Spiceland, Arvind J. Trindade, Majidah A. Bukhari, Omid Sanaei, Saowanee Ngamruengphong, Mouen A. Khashab

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background & Aims: It is not clear whether digital single-operator cholangioscopy (D-SOC) with electrohydraulic and laser lithotripsy is effective in removal of difficult biliary stones. We investigated the safety and efficacy of D-SOC with electrohydraulic and laser lithotripsy in an international, multicenter study of patients with difficult biliary stones. Methods: We performed a retrospective analysis of 407 patients (60.4% female; mean age, 64.2 years) who underwent D-SOC for difficult biliary stones at 22 tertiary centers in the United States, United Kingdom, or Korea from February 2015 through December 2016; 306 patients underwent electrohydraulic lithotripsy and 101 (24.8%) underwent laser lithotripsy. Univariate and multivariable analyses were performed to identify factors associated with technical failure and the need for more than 1 D-SOC electrohydraulic or laser lithotripsy session to clear the bile duct. Results: The mean procedure time was longer in the electrohydraulic lithotripsy group (73.9 minutes) than in the laser lithotripsy group (49.9 minutes; P <.001). Ducts were completely cleared (technical success) in 97.3% of patients (96.7% of patients with electrohydraulic lithotripsy vs 99% patients with laser lithotripsy; P =.31). Ducts were cleared in a single session in 77.4% of patients (74.5% by electrohydraulic lithotripsy and 86.1% by laser lithotripsy; P =.20). Electrohydraulic or laser lithotripsy failed in 11 patients (2.7%); 8 patients were treated by surgery. Adverse events occurred in 3.7% patients and the stone was incompletely removed from 6.6% of patients. On multivariable analysis, difficult anatomy or cannulation (duodenal diverticula or altered anatomy) correlated with technical failure (odds ratio, 5.18; 95% confidence interval, 1.26–21.2; P =.02). Procedure time increased odds of more than 1 session of D-SOC electrohydraulic or laser lithotripsy (odds ratio, 1.02; 95% confidence interval, 1.01–1.03; P <.001). Conclusions: In a multicenter, international, retrospective analysis, we found D-SOC with electrohydraulic or laser lithotripsy to be effective and safe in more than 95% of patients with difficult biliary stones. Fewer than 5% of patients require additional treatment with surgery and/or extracorporeal shockwave lithotripsy to clear the duct.

Original languageEnglish (US)
Pages (from-to)918-926.e1
JournalClinical Gastroenterology and Hepatology
Volume16
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Laser Lithotripsy
Safety
Lithotripsy
Anatomy
Odds Ratio
Confidence Intervals
Diverticulum
Korea
Bile Ducts
Catheterization
Multicenter Studies

Keywords

  • Biliary Tract
  • Blockage
  • Choledocholithiasis
  • Gallstone

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Brewer Gutierrez, O. I., Bekkali, N. L. H., Raijman, I., Sturgess, R., Sejpal, D. V., Aridi, H. D., ... Khashab, M. A. (2018). Efficacy and Safety of Digital Single-Operator Cholangioscopy for Difficult Biliary Stones. Clinical Gastroenterology and Hepatology, 16(6), 918-926.e1. https://doi.org/10.1016/j.cgh.2017.10.017

Efficacy and Safety of Digital Single-Operator Cholangioscopy for Difficult Biliary Stones. / Brewer Gutierrez, Olaya I.; Bekkali, Noor L.H.; Raijman, Isaac; Sturgess, Richard; Sejpal, Divyesh V.; Aridi, Hanaa D.; Sherman, Stuart; Shah, Raj J.; Kwon, Richard S.; Buxbaum, James L.; Zulli, Claudio; Wassef, Wahid; Adler, Douglas G.; Kushnir, Vladimir; Wang, Andrew Y.; Krishnan, Kumar; Kaul, Vivek; Tzimas, Demetrios; DiMaio, Christopher J.; Ho, Sammy; Petersen, Bret; Moon, Jong Ho; Elmunzer, B. Joseph; Webster, George J.M.; Chen, Yen I.; Dwyer, Laura K.; Inamdar, Summant; Patrick, Vanessa B.; Attwell, Augustin; Hosmer, Amy; Ko, Christopher; Maurano, Attilio; Sarkar, Avik; Taylor, Linda J.; Gregory, Martin H.; Strand, Daniel S.; Raza, Ali; Kothari, Shivangi; Harris, Jessica P.; Kumta, Nikhil A.; Manvar, Amar; Topazian, Mark D.; Lee, Yun Nah; Spiceland, Clayton M.; Trindade, Arvind J.; Bukhari, Majidah A.; Sanaei, Omid; Ngamruengphong, Saowanee; Khashab, Mouen A.

In: Clinical Gastroenterology and Hepatology, Vol. 16, No. 6, 01.06.2018, p. 918-926.e1.

Research output: Contribution to journalArticle

Brewer Gutierrez, OI, Bekkali, NLH, Raijman, I, Sturgess, R, Sejpal, DV, Aridi, HD, Sherman, S, Shah, RJ, Kwon, RS, Buxbaum, JL, Zulli, C, Wassef, W, Adler, DG, Kushnir, V, Wang, AY, Krishnan, K, Kaul, V, Tzimas, D, DiMaio, CJ, Ho, S, Petersen, B, Moon, JH, Elmunzer, BJ, Webster, GJM, Chen, YI, Dwyer, LK, Inamdar, S, Patrick, VB, Attwell, A, Hosmer, A, Ko, C, Maurano, A, Sarkar, A, Taylor, LJ, Gregory, MH, Strand, DS, Raza, A, Kothari, S, Harris, JP, Kumta, NA, Manvar, A, Topazian, MD, Lee, YN, Spiceland, CM, Trindade, AJ, Bukhari, MA, Sanaei, O, Ngamruengphong, S & Khashab, MA 2018, 'Efficacy and Safety of Digital Single-Operator Cholangioscopy for Difficult Biliary Stones', Clinical Gastroenterology and Hepatology, vol. 16, no. 6, pp. 918-926.e1. https://doi.org/10.1016/j.cgh.2017.10.017
Brewer Gutierrez OI, Bekkali NLH, Raijman I, Sturgess R, Sejpal DV, Aridi HD et al. Efficacy and Safety of Digital Single-Operator Cholangioscopy for Difficult Biliary Stones. Clinical Gastroenterology and Hepatology. 2018 Jun 1;16(6):918-926.e1. https://doi.org/10.1016/j.cgh.2017.10.017
Brewer Gutierrez, Olaya I. ; Bekkali, Noor L.H. ; Raijman, Isaac ; Sturgess, Richard ; Sejpal, Divyesh V. ; Aridi, Hanaa D. ; Sherman, Stuart ; Shah, Raj J. ; Kwon, Richard S. ; Buxbaum, James L. ; Zulli, Claudio ; Wassef, Wahid ; Adler, Douglas G. ; Kushnir, Vladimir ; Wang, Andrew Y. ; Krishnan, Kumar ; Kaul, Vivek ; Tzimas, Demetrios ; DiMaio, Christopher J. ; Ho, Sammy ; Petersen, Bret ; Moon, Jong Ho ; Elmunzer, B. Joseph ; Webster, George J.M. ; Chen, Yen I. ; Dwyer, Laura K. ; Inamdar, Summant ; Patrick, Vanessa B. ; Attwell, Augustin ; Hosmer, Amy ; Ko, Christopher ; Maurano, Attilio ; Sarkar, Avik ; Taylor, Linda J. ; Gregory, Martin H. ; Strand, Daniel S. ; Raza, Ali ; Kothari, Shivangi ; Harris, Jessica P. ; Kumta, Nikhil A. ; Manvar, Amar ; Topazian, Mark D. ; Lee, Yun Nah ; Spiceland, Clayton M. ; Trindade, Arvind J. ; Bukhari, Majidah A. ; Sanaei, Omid ; Ngamruengphong, Saowanee ; Khashab, Mouen A. / Efficacy and Safety of Digital Single-Operator Cholangioscopy for Difficult Biliary Stones. In: Clinical Gastroenterology and Hepatology. 2018 ; Vol. 16, No. 6. pp. 918-926.e1.
@article{e106f7247100410b8a9ebf12825b972b,
title = "Efficacy and Safety of Digital Single-Operator Cholangioscopy for Difficult Biliary Stones",
abstract = "Background & Aims: It is not clear whether digital single-operator cholangioscopy (D-SOC) with electrohydraulic and laser lithotripsy is effective in removal of difficult biliary stones. We investigated the safety and efficacy of D-SOC with electrohydraulic and laser lithotripsy in an international, multicenter study of patients with difficult biliary stones. Methods: We performed a retrospective analysis of 407 patients (60.4{\%} female; mean age, 64.2 years) who underwent D-SOC for difficult biliary stones at 22 tertiary centers in the United States, United Kingdom, or Korea from February 2015 through December 2016; 306 patients underwent electrohydraulic lithotripsy and 101 (24.8{\%}) underwent laser lithotripsy. Univariate and multivariable analyses were performed to identify factors associated with technical failure and the need for more than 1 D-SOC electrohydraulic or laser lithotripsy session to clear the bile duct. Results: The mean procedure time was longer in the electrohydraulic lithotripsy group (73.9 minutes) than in the laser lithotripsy group (49.9 minutes; P <.001). Ducts were completely cleared (technical success) in 97.3{\%} of patients (96.7{\%} of patients with electrohydraulic lithotripsy vs 99{\%} patients with laser lithotripsy; P =.31). Ducts were cleared in a single session in 77.4{\%} of patients (74.5{\%} by electrohydraulic lithotripsy and 86.1{\%} by laser lithotripsy; P =.20). Electrohydraulic or laser lithotripsy failed in 11 patients (2.7{\%}); 8 patients were treated by surgery. Adverse events occurred in 3.7{\%} patients and the stone was incompletely removed from 6.6{\%} of patients. On multivariable analysis, difficult anatomy or cannulation (duodenal diverticula or altered anatomy) correlated with technical failure (odds ratio, 5.18; 95{\%} confidence interval, 1.26–21.2; P =.02). Procedure time increased odds of more than 1 session of D-SOC electrohydraulic or laser lithotripsy (odds ratio, 1.02; 95{\%} confidence interval, 1.01–1.03; P <.001). Conclusions: In a multicenter, international, retrospective analysis, we found D-SOC with electrohydraulic or laser lithotripsy to be effective and safe in more than 95{\%} of patients with difficult biliary stones. Fewer than 5{\%} of patients require additional treatment with surgery and/or extracorporeal shockwave lithotripsy to clear the duct.",
keywords = "Biliary Tract, Blockage, Choledocholithiasis, Gallstone",
author = "{Brewer Gutierrez}, {Olaya I.} and Bekkali, {Noor L.H.} and Isaac Raijman and Richard Sturgess and Sejpal, {Divyesh V.} and Aridi, {Hanaa D.} and Stuart Sherman and Shah, {Raj J.} and Kwon, {Richard S.} and Buxbaum, {James L.} and Claudio Zulli and Wahid Wassef and Adler, {Douglas G.} and Vladimir Kushnir and Wang, {Andrew Y.} and Kumar Krishnan and Vivek Kaul and Demetrios Tzimas and DiMaio, {Christopher J.} and Sammy Ho and Bret Petersen and Moon, {Jong Ho} and Elmunzer, {B. Joseph} and Webster, {George J.M.} and Chen, {Yen I.} and Dwyer, {Laura K.} and Summant Inamdar and Patrick, {Vanessa B.} and Augustin Attwell and Amy Hosmer and Christopher Ko and Attilio Maurano and Avik Sarkar and Taylor, {Linda J.} and Gregory, {Martin H.} and Strand, {Daniel S.} and Ali Raza and Shivangi Kothari and Harris, {Jessica P.} and Kumta, {Nikhil A.} and Amar Manvar and Topazian, {Mark D.} and Lee, {Yun Nah} and Spiceland, {Clayton M.} and Trindade, {Arvind J.} and Bukhari, {Majidah A.} and Omid Sanaei and Saowanee Ngamruengphong and Khashab, {Mouen A.}",
year = "2018",
month = "6",
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language = "English (US)",
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journal = "Clinical Gastroenterology and Hepatology",
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TY - JOUR

T1 - Efficacy and Safety of Digital Single-Operator Cholangioscopy for Difficult Biliary Stones

AU - Brewer Gutierrez, Olaya I.

AU - Bekkali, Noor L.H.

AU - Raijman, Isaac

AU - Sturgess, Richard

AU - Sejpal, Divyesh V.

AU - Aridi, Hanaa D.

AU - Sherman, Stuart

AU - Shah, Raj J.

AU - Kwon, Richard S.

AU - Buxbaum, James L.

AU - Zulli, Claudio

AU - Wassef, Wahid

AU - Adler, Douglas G.

AU - Kushnir, Vladimir

AU - Wang, Andrew Y.

AU - Krishnan, Kumar

AU - Kaul, Vivek

AU - Tzimas, Demetrios

AU - DiMaio, Christopher J.

AU - Ho, Sammy

AU - Petersen, Bret

AU - Moon, Jong Ho

AU - Elmunzer, B. Joseph

AU - Webster, George J.M.

AU - Chen, Yen I.

AU - Dwyer, Laura K.

AU - Inamdar, Summant

AU - Patrick, Vanessa B.

AU - Attwell, Augustin

AU - Hosmer, Amy

AU - Ko, Christopher

AU - Maurano, Attilio

AU - Sarkar, Avik

AU - Taylor, Linda J.

AU - Gregory, Martin H.

AU - Strand, Daniel S.

AU - Raza, Ali

AU - Kothari, Shivangi

AU - Harris, Jessica P.

AU - Kumta, Nikhil A.

AU - Manvar, Amar

AU - Topazian, Mark D.

AU - Lee, Yun Nah

AU - Spiceland, Clayton M.

AU - Trindade, Arvind J.

AU - Bukhari, Majidah A.

AU - Sanaei, Omid

AU - Ngamruengphong, Saowanee

AU - Khashab, Mouen A.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background & Aims: It is not clear whether digital single-operator cholangioscopy (D-SOC) with electrohydraulic and laser lithotripsy is effective in removal of difficult biliary stones. We investigated the safety and efficacy of D-SOC with electrohydraulic and laser lithotripsy in an international, multicenter study of patients with difficult biliary stones. Methods: We performed a retrospective analysis of 407 patients (60.4% female; mean age, 64.2 years) who underwent D-SOC for difficult biliary stones at 22 tertiary centers in the United States, United Kingdom, or Korea from February 2015 through December 2016; 306 patients underwent electrohydraulic lithotripsy and 101 (24.8%) underwent laser lithotripsy. Univariate and multivariable analyses were performed to identify factors associated with technical failure and the need for more than 1 D-SOC electrohydraulic or laser lithotripsy session to clear the bile duct. Results: The mean procedure time was longer in the electrohydraulic lithotripsy group (73.9 minutes) than in the laser lithotripsy group (49.9 minutes; P <.001). Ducts were completely cleared (technical success) in 97.3% of patients (96.7% of patients with electrohydraulic lithotripsy vs 99% patients with laser lithotripsy; P =.31). Ducts were cleared in a single session in 77.4% of patients (74.5% by electrohydraulic lithotripsy and 86.1% by laser lithotripsy; P =.20). Electrohydraulic or laser lithotripsy failed in 11 patients (2.7%); 8 patients were treated by surgery. Adverse events occurred in 3.7% patients and the stone was incompletely removed from 6.6% of patients. On multivariable analysis, difficult anatomy or cannulation (duodenal diverticula or altered anatomy) correlated with technical failure (odds ratio, 5.18; 95% confidence interval, 1.26–21.2; P =.02). Procedure time increased odds of more than 1 session of D-SOC electrohydraulic or laser lithotripsy (odds ratio, 1.02; 95% confidence interval, 1.01–1.03; P <.001). Conclusions: In a multicenter, international, retrospective analysis, we found D-SOC with electrohydraulic or laser lithotripsy to be effective and safe in more than 95% of patients with difficult biliary stones. Fewer than 5% of patients require additional treatment with surgery and/or extracorporeal shockwave lithotripsy to clear the duct.

AB - Background & Aims: It is not clear whether digital single-operator cholangioscopy (D-SOC) with electrohydraulic and laser lithotripsy is effective in removal of difficult biliary stones. We investigated the safety and efficacy of D-SOC with electrohydraulic and laser lithotripsy in an international, multicenter study of patients with difficult biliary stones. Methods: We performed a retrospective analysis of 407 patients (60.4% female; mean age, 64.2 years) who underwent D-SOC for difficult biliary stones at 22 tertiary centers in the United States, United Kingdom, or Korea from February 2015 through December 2016; 306 patients underwent electrohydraulic lithotripsy and 101 (24.8%) underwent laser lithotripsy. Univariate and multivariable analyses were performed to identify factors associated with technical failure and the need for more than 1 D-SOC electrohydraulic or laser lithotripsy session to clear the bile duct. Results: The mean procedure time was longer in the electrohydraulic lithotripsy group (73.9 minutes) than in the laser lithotripsy group (49.9 minutes; P <.001). Ducts were completely cleared (technical success) in 97.3% of patients (96.7% of patients with electrohydraulic lithotripsy vs 99% patients with laser lithotripsy; P =.31). Ducts were cleared in a single session in 77.4% of patients (74.5% by electrohydraulic lithotripsy and 86.1% by laser lithotripsy; P =.20). Electrohydraulic or laser lithotripsy failed in 11 patients (2.7%); 8 patients were treated by surgery. Adverse events occurred in 3.7% patients and the stone was incompletely removed from 6.6% of patients. On multivariable analysis, difficult anatomy or cannulation (duodenal diverticula or altered anatomy) correlated with technical failure (odds ratio, 5.18; 95% confidence interval, 1.26–21.2; P =.02). Procedure time increased odds of more than 1 session of D-SOC electrohydraulic or laser lithotripsy (odds ratio, 1.02; 95% confidence interval, 1.01–1.03; P <.001). Conclusions: In a multicenter, international, retrospective analysis, we found D-SOC with electrohydraulic or laser lithotripsy to be effective and safe in more than 95% of patients with difficult biliary stones. Fewer than 5% of patients require additional treatment with surgery and/or extracorporeal shockwave lithotripsy to clear the duct.

KW - Biliary Tract

KW - Blockage

KW - Choledocholithiasis

KW - Gallstone

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