Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Dig Endosc. 2019 Mar;31(2):203-208. doi: 10.1111/den.13310. Epub 2019 Jan 18.
Efficacy of cholangioscopy-assisted lithotripsy for difficult stones such as huge stones, multiple large stones and an impacted stone in patients with non-altered anatomy has been reported. Herein, we describe peroral direct digital cholangioscopy (PDCS)-assisted electrohydraulic lithotripsy (EHL) with a new technique in patients with surgically altered anatomy. Five patients received PDCS-assisted EHL with the monorail technique due to failed conventional stone extraction. Balloon enteroscope was removed, leaving the stiff guidewire in the bile duct and an overtube with inflated balloons. The cholangioscope was then inserted into the bile duct over the wire through the overtube. After direct visualization of the stone, PDCS-assisted EHL was carried out. This technique was named the 'monorail technique'. Complete removal of biliary stones in one session was accomplished in four patients and only one case required two sessions. There was no adverse event in any of the cases. PDCS-assisted EHL using the monorail technique was effective and safe for difficult biliary stones in patients with surgically altered anatomy.
经口直接数字式胆管镜（PDCS）辅助电液压碎石术（EHL）已被报道在解剖结构未改变的患者中治疗巨大结石、多发大结石和嵌顿结石等困难结石具有疗效。在此，我们描述了 5 例因常规取石失败而接受经口直接数字式胆管镜（PDCS）辅助电液压碎石术（EHL）治疗的解剖结构改变患者。球囊内镜被取出，在胆管中留下硬导丝和带有充气球囊的外套管。然后，通过外套管将胆管镜插入胆管中的导丝上。在直视下直接观察到结石后，进行 PDCS 辅助 EHL。该技术被命名为“单轨技术”。4 例患者在一次治疗中完全取出了胆管结石，仅 1 例需要两次治疗。所有病例均无不良事件。在解剖结构改变的患者中，经口直接数字式胆管镜（PDCS）辅助电液压碎石术（EHL）联合单轨技术治疗困难胆管结石是有效且安全的。
