Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Surg Endosc. 2018 Jun;32(6):2704-2712. doi: 10.1007/s00464-017-5966-2. Epub 2017 Nov 3.
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.
尽管先前的研究已经报道了在没有透视的情况下进行治疗性 ERCP 的可能性，但需要更有力的无透视下胆总管结石（CBDS）清除的文件记录。从技术上讲，“数字胆管镜检查”（DCS）可用于确认 CBDS 清除。我们旨在比较接受 DCS 和常规 ERCP（cERCP）治疗的 CBDS 患者的可行性、安全性和辐射暴露。
2015 年 12 月至 2016 年 10 月期间，50 例 CBDS 大小<15mm 的连续患者接受了 DCS（波士顿科学公司的 SpyGlass DS 直接可视化系统，马萨诸塞州马尔伯勒）。在同一时间段内进行了 202 例连续 cERCP，使用倾向评分匹配分析创建了 50 对匹配对。在 DCS 组中，患者在没有透视的情况下进行胆道插管和 CBDS 切除，然后进行 DCS 以确认 CBDS 完全清除。最终闭塞胆管造影作为当前的护理标准进行，以确认 CBDS 清除。
DCS 组和 cERCP 组的胆管插管成功率相似（98%对 98%）。通过意向治疗分析，DCS 组和 cERCP 组的 CBDS 清除率无差异（90%对 98%；分别为 p=0.20）。DCS 成功清除了 45 例 CBDS，而 5 例（10%）由于技术限制而无法通过 DCS 清除。两组的不良事件无差异。
在处理简单的 CBDS 时，我们的数据证实了 DCS 用于 CBDS 清除的可行性，因为它显示了与 cERCP 相当的疗效和安全性。尽管某些情况可能会限制其有效性，但 DCS 能够在无需透视设备的情况下进行 CBDS 清除，并可以避免透视下 ERCP 时的辐射暴露，而透视下 ERCP 仍然是 CBDS 患者的当前标准治疗。
