Success Rate Of Stone Removal Research Articles

A retrospective comparison of endoscopic nasobiliary drainage (ENBD) and endoscopic retrograde biliary drainage (ERBD) in the treatment of acute cholangitis

Endoscopic nasobiliary drainage (ENBD) and endoscopic retrograde biliary drainage (ERBD) can rapidly alleviate obstruction, facilitate bile drainage, and reduce pressure in the bile duct. In this study, to evaluate the effect of plastic biliary stent on the recurrence rate of choledocholithiasis in patients with actual cholangitis after endoscopic retrograde cholangioangiography (ERCP), we a comparative analysis of the efficacy and safety between ENBD and ERBD in inflammatory remission rate, complication rate, and success rate of secondary or multiple endoscopic lithotomy. A total of 347 patients undergoing ENBD and ERBD were enrolled in this retrospective study. Preoperative assessments including blood tests, electrocardiography, abdominal ultrasonography, CT scans, MRI, or MRCP were conducted on all participants. Additionally, serum CRP and amylase levels were measured using a magnetic nanobead-based immunoassay. We found that The success rate of stone removal in the ENBD group was higher than that in the ERBD group (90.8% vs. 72.7%) (P <0.0001). The remission rate of inflammation in the ERBD group (100.0%) was higher than that in the ENBD group (98.7%) (P >0.05). No significant difference was observed between the ERBD group and the ENBD group in preoperative and postoperative inflammatory indexes (total bilirubin, direct bilirubin, white blood cells, neutrophils, CRP, and serum amylase). Moreover, there were significant differences in post-ERCP pancreatitis between the ERBD group and ENBD group. These results suggest that both ENBD and ERBD can effectively improve clinical efficacy. Moreover, magnetic nanobeads have good application in serum index detection to increase detection efficiency.

Case Series of Endoscopic Papillary Balloon Dilation for Children with Common Bile Duct Stones and a Review of the Literature.

Background: Endoscopic sphincterotomy (EST) has been employed for the endoscopic treatment of common bile duct stones (CBDSs) and has been reported to have a high success rate for stone removal. However, EST is associated with a risk of bleeding, perforation, and sphincter of Oddi function disruption. To avoid these risks, endoscopic papillary balloon dilation (EPBD) is an option for CBDS. Sphincter of Oddi function preservation decreases long-term biliary infection and gallstone recurrence. EPBD may have advantages in children who require a long follow up. However, there have been few reports on pediatric cases, particularly in infants. Methods: From September 2017 to December 2023, we performed EPBD for four pediatric CBDSs. The patients were aged from 5 months to 8 years, including two infants aged 5 and 6 months. Furthermore, we reviewed the stone removal rate and complications of 545 ESTs performed at high-volume centers and 13 EPBD-reported cases in children with CBDSs. Results: CBDSs of all patients who underwent EPBD in our institution were successfully removed. No bleeding or perforation was noted; pancreatitis was observed in three patients. In an analysis of 545 ESTs in children, the stone removal rate was high, ranging from 83% to 100% (mean 96%). The incidence of pancreatitis was 0-9.6% (mean 4.4%), and the grade of pancreatitis was almost mild. The bleeding frequency was 1.3-5.4% (mean 2.7%). With regards to the grade of bleeding, seven cases were mild (64%) and four were moderate (36%). Compared with adults who underwent EST, the frequencies of pancreatitis and bleeding were almost equal in children; however, in children, once bleeding occurs, it has a higher risk of leading to blood transfusion. Stone removal via EPBD in children has a 100% success rate. Pancreatitis was responsible for all complications were related; its frequency was 46% (6/13 patients, including five mild cases and one moderate case), which is higher than that of EST and adult cases who underwent EPBD. In most children with pancreatitis, pancreatic enzyme levels returned to normal within 2-3 days following EPBD, and no severe cases caused by EPBD were reported. Conclusions: CBDS removal via EPBD in children has a high success rate with very low risk of bleeding and perforation. Although pancreatitis frequently occurs, most cases are mild. Sphincter of Oddi function preservation via EPBD is expected to prevent long-term stone recurrence and biliary tract infection, and EPBD is considered to be an effective method for CBDS removal in children.

Changes in Gallbladder Contractile Function and its Influencing Factors After Minimally Invasive Gallbladder-Preserving Surgery for Cholecystitis With Incarcerated Gallstones.

BackgroundCholecystitis with incarcerated gallstones (CIG) is a type of acute abdomen in the field of hepatobiliary surgery. Whether gallbladder-preserving surgery (GPS) can be performed to treat it, however, depends on the improvement of gallbladder contractile function. The present study aimed to investigate the changes in gallbladder contractile function and its influencing factors after minimally invasive GPS for CIG.MethodsA total of 95 patients with CIG treated in the Aerospace Center Hospital between May 2017 and May 2019 were enrolled as the study subjects. All patients received minimally invasive GPS. The patients' operation-related conditions (including stone removal success rate, duration of surgery, intraoperative blood loss, etc.), changes in gallbladder contractile function, and influencing factors of GPS were analyzed.ResultsAmong the 95 patients included in the study, the success rate of stone removal was 100%, the duration of surgery was 76.0 ± 26.5 min, and the intraoperative blood loss was 10.17 ± 4.43 ml. The rate of good gallbladder contractile function at one and two years after surgery was significantly higher than before surgery (P < 0.05). Age, duration of surgery, stone recurrence, and diabetes were the independent risk factors for postoperative gallbladder contractile function (P < 0.05).ConclusionMinimally invasive GPS for patients with CIG has a good curative effect. The changes in gallbladder contractile function after the surgery are influenced by many factors.

Surgical Outcomes of Sialendoscopy-Assisted Approaches for Removal of Parotid Gland Stones

Background and Objectives With the introduction of sialendoscopy, minimal invasive surgery has become possible for the removal of sialoliths, although sialendoscopic removal of parotid stones remains a surgical challenge. Sialendoscopic stone removal can be differently applied according to the location and size of stones. This study was conducted to evaluate the surgical outcomes of sialaendoscopic stone removal and to provide a strategy for choosing an adequate surgical approach according to the characteristics of parotid stones.Subjects and Method A retrospective study was conducted of 43 patients with parotid sialolithiasis who were treated by sialendoscopic stone removal between March 2017 and January 2021. Surgical techniques were classified into sialendoscopy alone (SA), sialendoscopy-assisted transoral approach (STO), and sialendoscopy-combined retroauricular approach (SRA). The parotid gland stones were categorized by size, location, and multiplicity.Results Of the 43 patients, 13 patients underwent SA, 10 received STO, and 20 were treated with different SRA approaches. The SRA approaches included three distal, seven proximal, and ten intraglandular stone removal cases. The success rate of stone removal was 92% (12 cases) by SA, 90% (9 cases) by STO, and 100% (20 cases) by SRA. In cases of SA and STO, all patients had distant stones except for one who had proximal stones. Postoperative complications including pain, swelling, wound dehiscence, sialocele, duct stricture, and facial palsy mainly occurred in cases treated with SRAs.Conclusion Appropriate use of various sialendoscopy-assisted approaches is mandatory to preserve the gland and minimize surgical complications in patients with different features of parotid gland stones.

The Effect of Propofol on the Success Rate of Transurethral Lithotripsy by Holmium Laser: A Randomized Clinical Trial.

Introduction: Urinary stone disease is the third most common affliction of the urinary tract that has been associated with an increasing incidence. Over decades, great advances have been made in the minimally invasive treatment of urinary stones. Recently, transurethral lithotripsy (TUL) by holmium laser was introduced as a possible therapeutic option. This study evaluated the effect of propofol on the success rate of TUL by holmium laser. Methods: A double-blind randomized controlled trial was conducted on 180 patients to investigate the effect of propofol on the success and complication rate of TUL by holmium laser. The enrolled patients were divided into two groups: the first group received sodium thiopental (n=89) while the second group received propofol (n=91). The two groups were compared in terms of the fluctuations of systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), operation time, future stone-free rate (SFR), stone migration, post-operative fever, and ureteral complications such as perforation and mucosal damage. Other developed complications were also recorded. After data gathering, statistical analysis was performed with SPSS version 21. Results: the patients' data such as age, sex, stone diameter, stone laterality, duration of stone impaction, primary SBP, DBP and HR were not significantly different between the two groups (P>0.05). TUL and anesthesia duration, first-minute and fifth-minute SBP and DBP, and also changes of HR were significantly lower in the propofol group compared with the sodium thiopental group (P <0.001). Moreover, SFR of TUL was more evident in the propofol group. Ureteral mucosal damage was significantly less in the propofol group. Conclusion: Propofol was associated with a higher reduction in SBP and DBP, decreased duration of TUL, fewer fluctuations in HR, and an increased success rate of stone removal by TUL with holmium laser.

Curative effects and prognosis of endoscopic papillary large balloon dilatation on the treatment of choledocholithiasis

Objective To evaluate the curative effect and prognosis of endoscopic papillary large balloon dilatation (EPLBD) in the treatment of choledocholithiasis. Methods A total of 153 patients with choledocholithiasis (>1.0 cm in stone diameter) admitted and treated in Shanxi People′s Hospital from August 2016 to November 2017 were randomly divided into two groups according to the random number table: the EPLBD group (n=83) and the small endoscopic sphincterotomy plus large balloon dilatation (ESLBD) group (n=70) . The success rate of stone removal, the rate of lithotripsy, and the incidence of short-term and long-term complications were compared between the two groups. Results There were no statistical differences between the EPLBD group and the ESLBD group in total stone removal rate [95.2% (79/83) VS 97.1% (68/70) , χ2=0.388, P=0.533] and one-time stone removal rate [92.8% (77/83) VS 90.0% (63/70) , χ2=0.375, P=0.540]. The lithotripsy rate between the two groups had no statistical difference [25.3% (21/83) VS 35.7% (25/70) , χ2=1.958, P=0.162]. There was no statistical difference in the incidence of recent complications between the two groups [43.4% (36/83) VS 40.0% (28/70) , χ2=0.178, P=0.673]. No postoperative perforation was found in either group. The follow-up time was 22.7±4.3 months in the EPLBD group, and 20.8±6.3 months in the ESLBD group.The cumulative recurrent rate of choledocholithiasis in the two groups were 2.4% (2/83) and 15.7% (11/70) , respectively, and the difference was significant (P=0.003) . Conclusion Simple EPLBD in the treatment of choledocholithiasis is equivalent to ESLBD in the success rate of stone removal, utilization rate of lithotripsy, and incidence of recent complications, but the long-term stone recurrence rate of EPLBD is lower than that of ESLBD. EPLBD is effective and safe on the treatment of choledocholithiasis. Key words: Choledocholithiasis; Cholangiopancreatography, endoscopic retrograde; Endoscopic papillary large balloon dilatation; Small endoscopic sphincterotomy plus large balloon dilatation

Endoscopic papillary balloon dilation in treatment of choledocholithiasis associated with peripapillary duodenal diverticulum

Objective To evaluate the use of endoscopic papillary balloon dilation in treatment of choledocholithiasis associated with peripapillary duodenal diverticulum. Methods From January 2017 to July 2018, a retrospective study was conducted on 124 patients with choledocholithiasis associated with peripapillary duodenal diverticula at the Department of Hepatobiliary Surgery, Second Hospital of Hebei Medical University. These patients were divided into the small endoscopic sphincterotomy combined with balloon dilation group (sEST+ EPBD, n=60) and the simple papillary balloon dilation group (EPBD n=64). The operation time, one-time success rate of stone removal, complication and hospitalization stay were compared between the two groups of patients. Results The hospitalization expenses of the EPBD group was significantly less than the sEST+ EPBD group (P 0.05). Conclusions Compared with sEST+ EPBD, treatment of choledocholithiasis in patients with peripapillary duodenal diverticula using simple balloon dilation shortened the operation time, did not increase the complication rates and hospitalization stay. The procedure was safe and effective, and resulted in almost the same one-time success rate of stone removal. Key words: Endoscopic retrograde cholangiopancreatography; Parapapillary duodenal diverticula; Choledocholithiasis; Endoscopic papillary balloon dilation

Endoscopic Papillary Large Balloon Dilation Versus Endoscopic Sphincterotomy for Retrieval of Large Choledocholithiasis: A Prospective Randomized Trial

Endoscopic sphincterotomy (ES) is the standard technique for common bile duct (CBD) stone removal. Recently, endoscopic papillary large balloon dilation (EPLBD) has been shown to be a safe and effective technique for the removal of large CBD stone. The aim of this study was to determine the therapeutic outcomes and safety of EPLBD compared with ES for large CBD stone extraction. One hundred twenty-four patients with large bile duct stones were randomized into two groups, the first group included 61 patients subjected to EPLBD and the second group included 63 patients who underwent ES. We compared the success rate of stone removal, frequency of mechanical lithotripsy requirement, morbidity, and mortality. Baseline characteristics were not significantly different. The overall ductal clearance rate was ultimately similar between the EPLBD group (96.7%) and the ES group (93.7%) (P = .53), the one session ductal clearance rate was significantly different (86.9% versus 71.4%; P = .01). Requirement of mechanical lithotripsy was significantly different between the EPLBD and ES group (9.8% versus 17.5%, P = .04). There were no differences in complication rates between the EPLBD and ES group; pancreatitis, 4.9% versus 6.3%; minor hemorrhage, 1.6% versus 6.3%; acute cholangitis, 3.3% versus 1.9%; and recurrent stones, 3.3% versus 3.2%. The therapeutic outcomes of EPLBD for removal of large bile duct stones are better than those of ES with comparable complication rate. EPLBD is also recommended for removal of large CBD stone in patients with an underlying coagulopathy or need for anticoagulation following endoscopic retrograde cholangiopancreaticography.

Value of endoscopic sphincterotomy with small incision combined with balloon dilatation in the treatment of choledocholithiasis with juxtapapillary duodenal diverticula

Objective To explore the efficacy of endoscopic sphincterotomy with small incision combined with balloon dilatation (sEST+ EPBD) in the treatment of patients with choledocholithiasis and juxtapapillary duodenal diverticula (JPDD). Methods From January 2011 to January 2015, 149 patients with choledocholithiasis and JPDD who underwent endoscopic retrograde cholangio-pancreatography (ERCP) were enrolled.Among them, 60 patients were in sEST+ EPBD group and 89 were in endoscopic sphincterotomy (EST) group. Success rate of ERCP and first-time stone removal, changes of total bilirubin (TBil) and direct bilirubin (DBil) levels, as well as the incidence of postoperative complications between the two groups were compared. Chi-square test or t-test was performed for statistical analysis. Results The ERCP success rate sEST+ EPBD group was 100.0%(60/60), and the first-time success rate of stone removal was 91.7%(55/60); correspondingly, ERCP success rate of EST group was 98.9%(88/89), and the success rate of first-time stone removal was 77.5%(69/89). There was no statistically significant difference in success rate of ERCP between the two groups (χ2=0.19, P=0.410). The first-time success rate of stone removal of sEST + EPBD group was higher than that of EST group, and the difference was statistically significant (χ2=5.53, P=0.020). After operation, the TBil level of sEST+ EPBD group was (152.62±109.04) μmol/L, which was lower than that before operation ((266.02±143.31) μmol/L), and the difference was statistically significant (t=4.88, P<0.01). After operation, the DBil level of sEST + EPBD group was (87.13±65.90) μmol/L, which was lower than that before operation ((175.70±100.53) μmol/L), and the difference was statistically significant (t=5.71, P<0.01). After operation, the TBil level of EST group was (251.90±247.90) μmol/L, which was lower than that before operation ((340.20±176.20) μmol/L), and the difference was statistically significant (t=2.74, P<0.05). After operation, the DBil level of EST group was (168.10±140.60) μmol/L, which was lower than that before operation ((228.40±139.60) μmol/L), and the difference was statistically significant (t=2.87, P=0.005). The complication rate of sEST+ EPBD group after operation was 8.3%(5/60), which was lower than that of EST group (20.2%, 18/89), and the difference was statistically significant (χ2=3.88, P=0.049). Conclusion sEST+ EPBD could increase the first-time success rate of stone removal in patients with choledocholithiasis and JPDD, and it is a safe and effective treatment. Key words: Choledocholithiasis; Juxtapapillary duodenal diverticula; Endoscopic sphincterotomies; Balloon dilatation

Outcome of ureteroscopy for the management of distal ureteric calculi: 5-years’ experience

ObjectiveTo review our 5 years’ experience with ureteroscopy treatment of distal ureteric calculi. Patients and methodsWe reviewed the medical records of 136 patients who underwent ureteroscopic procedures for the treatment of distal ureteric calculi from February 2007 to October 2012. Patient and stone characteristics, treatment modality and outcome were assessed. Procedure's duration, status “stone free” and hospital stay were also evaluated. The mean clinical and radiological follow-up period was 31.8 months for 74.2% of eligible patients. ResultsThe stone free rate following an initial ureteroscopy was 79.4. The ultimate success rate for stone removal after “second look” improved to 95.9%. The mean operative duration was 51minutes.The intraoperative complication rate was 8.6%, the postoperative complication rate was 7.5%, and the mean hospital stay was 1.1 days.We could detect one ureteric stricture and one vesico-ureteric reflux (0.9% for each). A significant ureteric perforation was detected in 4.1% and ureteric perforation in 0.7% of the study group.We could find that the longer the operative duration, the greater the complications.Stone impaction and size were also found associated with higher morbidity. ConclusionGrowing skills and experience of ureteroscopy will lead to a significant increase in the success rate and also reducing serious complications.

The development of ureteric strictures after ureteroscopic treatment for ureteric calculi: A long-term study at two academic centres

ObjectiveTo determine the incidence of symptomatic and ‘silent’ obstruction after ureteroscopic procedures. Patients and methodsIn all, 1980 patients underwent ureteroscopy for ureteric calculi in two large centres. The methods of disintegration, auxiliary procedures used and type of stenting were considered. Intraoperative complications, in addition to the size and site of the stone, were assessed in relation to postoperative obstruction. The mean (range) follow-up was 42 (12–68) months, with patients assessed after 3–6months and yearly thereafter. The postoperative evaluation included an assessment of pain, renal ultrasonography, a plain abdominal film, intravenous urography, and a diuretic renal scan in some cases to confirm obstruction. ResultsThe success rate of stone removal was 98.5%. The failures were related to the size of the stone (>2cm; P<0.001). In eight patients there was a ureteric perforation, and six of these developed a ureteric stricture. A stricture also occurred in 12 patients (0.6%) during the follow-up; these included nine of 204 with stones of >2cm (4.4%), compared to three (0.17%) of 1746 patients with stones of <2cm (P<0.001). Fourteen patients presented with pain (0.7%), and five had no obstruction, while in nine (0.46%) the pain was associated with obstruction. There was silent obstruction in three cases (0.15%). The negative and positive predictive values for pain were 99.8% and 64.3%, respectively. ConclusionsRadiographic surveillance for stricture formation and obstruction is mandatory in patients who are symptomatic after ureteroscopy, and for up to 18months in patients with intraoperative complications or with a stone of >2cm in the proximal ureter.

Endoscopic papillary large‐balloon dilation versus endoscopic papillary regular‐balloon dilation for removal of large bile‐duct stones

Endoscopic papillary large-balloon dilation (EPLBD) became popular for the treatment of large common bile-duct stones (CBDS), and its feasibility has been reported in comparison to endoscopic sphincterotomy. However, the comparison between EPLBD and endoscopic papillary regular-balloon dilation (EPBD) has not been reported. In the present study, the efficacy and complications of EPLBD were compared with those of EPBD. We retrospectively assessed 334 consecutive patients with CBDS of any size that were treated by either EPLBD or EPBD between January 2008 and December 2012. In cases with large CBDS (>10 mm), EPLBD and EPBD had similar results in terms of the success rate of stone removal in the first (65% vs. 84%) and total attempts (100% vs. 95%), use of mechanical lithotripter (64% vs. 80%), and procedure time (48.0 ± 17.8 min vs. 44.1 ± 17.1 min). The necessity for crushing stones with a mechanical lithotripter was significantly decreased in EPLBD compared to EPBD (25% vs. 80%). In all cases with CBDS, there was no significant difference in complication rates between EPLBD and EPBD (3.3% vs. 4.7%). Compared to EPBD, EPLBD appears safe and effective for removing large CBDS and decreases the necessity of lithotripsy.

Impact of official technical training for urologists on the efficacy of shock wave lithotripsy

To evaluate the efficacy of company-initiated training of urologists on shock wave lithotripsy (SWL) treatment results, we retrospectively assessed 602 patients who underwent SWL in Nagoya City University Hospital between January 2004 and June 2011 using Lithotripter S (Dornier MedTech, Japan). Training-provided by a training specialist of the company in June 2010-focused on the targeting of renal and proximal ureter stones with a combination of radiography and ultrasonography (US). The stretcher wedges were positioned in the semi-prone position or the semi-supine position for middle and distal ureter stones, respectively. Success rates between 519 pre-training treatments and 83 post-training treatments were compared. Patient age and stone location, burden, number, and composition did not significantly differ between pre- and post-training. Training improved the overall success rate from 66.3 to 87.2% (P<0.0001). The mean number of SWL treatments decreased from 1.8±1.8 to 1.4±1.3 (P=0.01). The first SWL treatment success rate increased from 67.1 to 83.7% (P=0.002), and the need for multiple treatments decreased. The frequency of detection of renal and proximal ureter stones by both radiography and US increased from 10.5% before training to 58.2% after training (P<0.0001). Significant factors for successful SWL were determined to be training and prone position for distal ureter stones by multivariate analysis and ultrasonic detection for renal and proximal ureter stones by univariate analysis. Skills in targeting stones using ultrasonography and selecting the proper therapeutic position are essential for improving the success rate of stone removal.

Endoscopic papillary balloon intermittent dilatation and endoscopic sphincterotomy for bile duct stones

To compare the effectiveness and safety of endoscopic papillary balloon intermittent dilatation (EPBID) and endoscopic sphincterotomy (EST) in the treatment of common bile duct stones. From March 2011 to May 2012, endoscopic retrograde cholangiopancreatography was performed in 560 patients, 262 with common bile duct stones. A total of 206 patients with common bile duct stones were enrolled in the study and randomized to receive either EPBID with a 10-12 mm dilated balloon or EST (103 patients in each group). For both groups a conventional reticular basket or balloon was used to remove the stones. After the procedure, routine endoscopic nasobiliary drainage was performed. First-time stone removal was successfully performed in 94 patients in the EPBID group (91.3%) and 75 patients in the EST group (72.8%). There was no statistically significant difference in terms of operation time between the two groups. The overall incidence of early complications in the EPBID and EST groups was 2.9% and 13.6%, respectively, with no deaths reported during the course of the study and follow-up. Multiple regression analysis showed that the success rate of stone removal was associated with stone removal method [odds ratio (OR): 5.35; 95%CI: 2.24-12.77; P = 0.00], the transverse diameter of the stone (OR: 2.63; 95%CI: 1.19-5.80; P = 0.02) and the presence or absence of diverticulum (OR: 2.35; 95%CI: 1.03-5.37; P = 0.04). Postoperative pancreatitis was associated with the EST method of stone removal (OR: 5.00; 95%CI: 1.23-20.28; P = 0.02) and whether or not pancreatography was performed (OR: 0.10; 95%CI: 0.03-0.35; P = 0.00). The EPBID group had a higher success rate of stone removal with a lower incidence of pancreatitis compared with the EST group.

Percutaneous Approach for Removal of Difficult Common Bile Duct Stones

See Usefulness of Percutaneous Transhepatic Cholangioscopic Lithotomy for Removal of Difficult Common Bile Duct Stones by Jae Hyung Lee, Hyung Wook Kim, Dae Hwan Kang, et al., on page 65-70 Bile duct stone disease is one of the most common problems in medical practice. Surgical common bile duct (CBD) exploration was the procedure of choice for the treatment of bile duct stones a few decades ago. However, endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy has become the treatment of choice for bile duct stones after the development of ERCP techniques. Development of devices and techniques used in endoscopic sphincterotomy and stone extraction has increased the success rate of stone removal. Meanwhile, endoscopic sphincterotomy may be difficult or impossible in some clinical situations, including duodenal or pyloric stenosis, unusual biliary anatomy, previous gastrointestinal surgery such as Billroth II and Roux-en-Y gastrojejunostomy reconstruction, bilioenteric anastomosis, and patients' intolerance. As a surgical modality, laparoscopic biliary surgery has been widely used. Laparoscopic CBD exploration (transcystic or transcholedochal) is the most commonly used method for managing difficult CBD stones. However, general anesthesia is necessary to perform the surgery and the cost of the procedure is high. The success rate in performing laparoscopic CBD exploration is approximately 86% to 95% with 5% to 18% complication rates.1 Percutaneous transhepatic stone removal is another important technique among the nonoperative managements of bile duct stones. Percutaneous transhepatic stone extraction and expulsion into the duodenum was first reported in 1979.2 Percutaneous transhepatic cholangioscopy (PTCS) can be combined with these techniques. Balloon dilatation of the sphincter of Oddi has been widely used to facilitate stone removal procedure in order to allow biliary stone passage. Several techniques including basket forceps, electrohydraulic lithotripsy (EHL), and laser lithotripsy are now available for fragmentation of large stones.3 Variable major and minor complications of this technique including cholangitis, biliary pleural effusion, and self-limiting hemobilia have been reported. Lee et al.4 reported 100% success rate of PTCS lithotomy for removal of difficult CBD stones in 33 cases. EHL was used in most patients. Complications related with PTCS lithotomy, including fever, pancreatitis, and hemobilia, occurred in 15 patients (45.5%) but were ameliorated with conservative management. The mean procedure number of PTCS lithotomy was 2.8 and the numbers of EHL session were one session in 16, two sessions in nine, three sessions in five, and more than four sessions in two patients. The major indications of PTCS were altered anatomy due to previous stomach surgery (16 cases) and impacted stones (11 cases). Fifteen patients had prior cholecystectomy, but the paper did not mention the presence of gallbladder stone in another 18 patients with intact gallbladder. Because PTCS is an invasive procedure, declining quality of life and requiring additional time for dilatation, maturation and repeated procedure, this procedure should be considered in really difficult cases in which duodenoscope insertion into ampulla is impossible. If biliary cannulation is possible but stone is impacted in CBD, we should know that there are emerging new techniques such as endoscopic biliary lithotripsy using FREDDY laser5 and direct peroral cholangioscopy (POC) with ultraslim endoscopy.6 Holmium laser lithotripsy under direct POC using an ultrathin upper endoscope was also reported as an effective and safe technique for removal of difficult CBD stones.7 Laparoscopic CBD exploration and cholecystectomy are another options if the patients have both gallbladder and CBD stones and medical conditions which are tolerable to general anesthesia. Lee et al.8 reported that laparoscopic CBD exploration is a safe and effective treatment modality for CBD stones not only for younger patients but also for elderly patients (over 70 years). They suggested the laparoscopic CBD exploration as the first treatment strategy for difficult CBD stones as there were no significant differences in mean operation time, postoperative hospital stay, first meal time, recurrence rate, remnant stone, and complication or mortality rates in both groups. Because this study on PTCS lithotomy4 was a retrospective study conducted between 2008 and 2010, new techniques were not considered and PTCS lithotomy was done in cases with impacted CBD stones regardless of biliary cannulation by conventional ERCP. Nevertheless, this paper confirmed that PTCS lithotomy is a safe and effective treatment modality in difficult CBD stones if conventional ERCP with lithotripsy was impossible.

Sialendoscopy: A new diagnostic and therapeutic tool

Sialendoscopy is a recently developed minimally invasive diagnostic and therapeutic procedure for the management of obstructive diseases of the salivary glands. This report describes our early experience with this new tool and compares our results with the literature data. This was a retrospective analysis of the 33 first cases treated at a teaching hospital from October 2009 to June 2011. The success rate for diagnostic sialendoscopy was 94%. Sialolithiasis was found in 19 cases and salivary duct stenosis in 11; no canal anomaly was found in two cases. The success rate for stone removal was 79%, while treatment of strictures failed in four cases. Longer surgical experience led to shorter operating times and improved indications as well as better therapeutic outcomes. There were no complications. Sialendoscopy is a safe technique that can easily be learned by surgeons familiar with endoscopic surgery. However, practical experience is needed to reduce operating times, lower failure rates and determine its precise indications.

PTU-247 ERCP—can a small volume unit provide a satisfactory service?

IntroductionIn recent years, systems grading ERCP technical difficulty have been introduced in UK clinical practice. According to these, small volume units are advised to refer complex cases to specialised centres....

Sialoendoscopically-assisted sialolithectomy for the hilar stones of the Wharton's duct

To investigate the clinical effects of sialoendoscopically-assisted sialolithectomy for the sialolithiasis in the hilum of the submandibular glands. Between December 2005 and March 2011, treated 80 cases of radiography-verified sialiolithiasis in the hilum of the submandibular glands, The patients included 42 males and 38 females aged from 13 to 68 years. All these patients underwent sialoendoscopic observation and sialoendoscopically-assisted sialolithectomy and were followed up periodically for 3 - 6 months after operation. The success rate of stone removal, postoperative complications and clinical effects were analysed. The stones were completely removed in 71 cases, and almost completely removed in 5 cases, with a successful rate of 95% (76/80). Among 76 successful cases, 8 were treated by basket entrapment, 59 by intraoral open surgery and 9 by both of these two techniques. Within 3 - 6 months' follow-up, 1 case suffered temporary lingual nerve parenthesis and two suffered ranula formation. Sialoendoscopically-assisted sialolithectomy is a safe and effective gland-preservation technique for the patients with the hilum of the submandibular glands.

Endoscopic Versus Surgical Treatment of Downstream Pancreatic Duct Stones in Chronic Pancreatitis

Pancreatic duct stone is thought not only to be the cause of abdominal pain but also to be a risk factor for pancreatic cancer. Several treatment options have been implemented in the treatment of pancreatic duct stones. Stone location is a critical factor in selecting treatment. We present the results of 27 endoscopic treatments and 35 surgical treatments performed in three hospitals at a single university between January 2000 and January 2005. The results were compared retrospectively in terms of success rate of stone removal, length of hospital stay, complications, pain relief, and changes of pancreatic functions. In our study, endoscopy resulted in a similar success rate of stone removal and short-term pain relief rate as the surgical approach and with a shorter length of hospital stay. However, the surgical group had a more favorable long-term clinical result, as well as a lower number of hospital readmissions at the 5-year follow-up point. Based on long-term results, surgical treatment is more effective than endoscopy.

Use of NTrap® during Ureteroscopic Lithotripsy for Upper Ureteral Stones

PurposeThis study aimed to determine the value of the NTrap® (Cook Urological INC, USA), which was designed to block the upward movement of stones during ureteroscopic lithotripsy.Materials and MethodsWe reviewed the data of 144 patients who underwent ureteroscopic lithotripsy for an upper ureteral stone from June 2006 to May 2010. Sixty-eight patients who underwent ureteroscopic lithotripsy without the use of the NTrap® were assigned to Group I and 76 patients who underwent ureteroscopic lithotripsy with the NTrap® were assigned to Group II. The size of the stones, operation time, success rate, and pre- and postoperative complications were compared retrospectively between the two groups.ResultsThe mean age of the patients (Group I: 35.8 years; Group II: 32.6 years) and the sex ratios were not significantly different between the two groups. The mean size of the stones was 6.9 mm and 7.4 mm, which also was not significantly different between the two groups. The mean operation time was 82.7 minutes and 78.7 minutes. The operation time was shorter in Group II, but the difference was not significant. The success rate of stone removal was 89.7% and 98.7% in Groups I and II, respectively; Group II showed a significantly higher success rate. Two cases of ureteral perforation and one case of ureteral avulsion occurred in Group I, and one case of ureteral perforation occurred in Group II.ConclusionsNTrap®, which is an instrument used to assist during ureteroscopic lithotripsy, can be considered to be an effective tool that blocks the upward movement of the stone and aids in safe stone removal.