Su1585 EFFICACY OF ENDOSCOPIC MANAGEMENT FOR CONFLUENCE STONES

Abstract

Confluence stone (CS), which causes type II Mirizzi syndrome, has considered to be difficult to treat endoscopically. Endoscopic treatment of CS with lithotripsy has been reported, however, its feasibility is still unclear. To examine the clinical outcomes of endoscopic removal of CS. Patients who underwent endoscopic treatment for CS in our hospital from April 2010 to March 2019 were analyzed retrospectively. The biliary stone which between common bile duct and cystic duct was considered as CS. The strategy of CS removal is as follows; endoscopic stone extraction using balloon/basket catheter and/or mechanical lithotripsy (EML) was tried initially; in casae without successful stone removal, lithotripsy, such as extracorporeal shock wave lithotripsy (ESWL) or electrohydraulic lithotripsy (EHL), was conducted before endoscopic removal. The measured outcomes were complete stone clearance rate and adverse event. A total of 21 consecutive patients (14 males and 7 females; median 65 years old) with CS were included in the study. The median CBD diameter and stone size were 9 mm (4-14 mm) and 10 mm (7-17 mm), respectively, and comorbid bile duct stone was present in 2 patients. Before the initial trial of endoscopic CD removal, 9 and 2 patients underwent endoscopic sphincterotomy (EST) and endoscopic papillary large balloon dilation (EPLBD), respectively. Endoscopic stone removal without ESWL/EHL were achieved in 6 (28.6%) patients, and the median procedureal time was 27 (range, 7-77) min. The devices used for CD extraction were balloon catheter in 6, basket catheter in 9, and EML in 12. Among 15 patients of failed CD extraction, 14 patients underwent ESWL. The median number of session and pulse were 1 (1-4) time and 5000 shots per a session. After ESWL, CD extraction was achieved in all cases. Meanwhile, another patient underwent EHL, and complete stone removal was obtained after 829 shots. No adverse event was observed. Although CS removal under endoscopic treatment alone is difficult, endoscopic CS removal is feasible and safe with ESWL or EHL.