Endoscopy Unit, Department of Gastroenterology, Shenzhen Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Shenzhen, China.
Dig Endosc. 2018 May;30(3):364-371. doi: 10.1111/den.12989. Epub 2017 Dec 27.
Large impacted or residual invisible common bile duct (CBD) stones after mechanical lithotripsy are challenging. We aimed to evaluate the feasibility and success rate of a new hybrid anchoring balloon-guided direct peroral cholangioscopy (POC) for these conditions using an ultraslim endoscope.
Sixty-five patients with large or residual invisible CBD stones for direct POC from July 2012 to July 2016 were identified, including six cases in whom an additional interventional procedure was required. There were altogether 55 cases undergoing a procedure with our new device, with a 0.021-inch guidewire tied to a balloon catheter at its distal end in this single-center retrospective study. Technical success, procedure time, diagnostic and therapeutic efficacy of direct POC, and procedure-related complications were studied.
The hybrid anchoring balloon-guided direct POC was successful in 51/55 (92.7%) procedures, including 18 cases in whom the conventional wire-guided method failed within 25 min. Mean time for technical success by our method was 12.4 ± 3.4 min. In total, of the 43 cases with previous removal of CBD stones, seven (16.3%) were found to have residual stones ≥4 mm, excluding three cases in whom direct POC failed. In another 25 cases for difficult stones, 24 lithotripsies were carried out, resulting in 23 complete fragmentations. No significant procedure-related complications were observed.
The new hybrid anchoring balloon device performs well in facilitating direct POC using an ultraslim endoscope for evaluation and extraction of residual or large impacted CBD stones.
机械碎石后遗留的大的或隐匿性胆总管（CBD）结石是一个挑战。我们旨在评估使用超细内镜通过新型混合锚定球囊引导的直接经口胆镜检查（POC）治疗这些情况的可行性和成功率。
2012 年 7 月至 2016 年 7 月期间，我们共确定了 65 例需直接 POC 的大的或隐匿性 CBD 结石患者，其中 6 例需要额外的介入治疗。共有 55 例患者在我们的新设备下行该操作，在这项单中心回顾性研究中，在球囊导管的远端系上一根 0.021 英寸的导丝。研究了直接 POC 的技术成功率、操作时间、诊断和治疗效果以及与操作相关的并发症。
51/55（92.7%）例患者通过混合锚定球囊引导的直接 POC 获得成功，其中 18 例患者在 25 分钟内常规导丝引导法失败。我们的方法获得技术成功的平均时间为 12.4±3.4 分钟。在 43 例曾行 CBD 结石取出术的患者中，7 例（16.3%）发现残留结石≥4mm，不包括 3 例直接 POC 失败的患者。在另外 25 例困难结石患者中，24 例进行了碎石术，导致 23 例完全碎裂。未观察到明显与操作相关的并发症。
新型混合锚定球囊装置在使用超细内镜辅助评估和提取残留或大的嵌顿性 CBD 结石方面，性能良好，有助于直接 POC。
