Korean J Gastroenterol.  2022 Oct;80(4):163-168. 10.4166/kjg.2022.117.

Single-operator Cholangioscopy Guided Lithotripsy

• Shin J
• Oh CH
• Dong SH

• KMID: 2534464
• DOI: http://doi.org/10.4166/kjg.2022.117

Abstract

ERCP is the standard treatment for common bile duct stones (CBD stones). On the other hand, in approximately 10% of patients with CBD stones, the complete removal of the stones cannot be achieved by conventional ERCP, which performs endoscopic sphincterotomy followed by stone extraction. Additional advanced and complex procedures are often necessary to remove these “difficult bile duct stones”, including endoscopic papillary large balloon dilatation or mechanical lithotripsy. Advances in cholangioscopy have made electrohydraulic or laser lithotripsy under direct endoscopic visualization possible during ERCP. Cholangioscopy-guided lithotripsy using the SpyGlass DS system could be a better treatment tool for removing difficult stones. The focus of this review was to describe single-operator cholangioscopy in the management of difficult CBD stones.

Keyword

Cholangiopancreatography; endoscopic retrograde; Choledocholithiasis; Lithotripsy; Cholangioscopy

Figure

• 

  Fig. 1 Single-operator cholangioscopy using the SpyGlass DS system. (A) The SpySope is inserted into the duodenoscope through the working channel. (B) A single endoscopist controls both the duodenoscope and SpyScope (the reason this is called “single-operator” cholangioscopy). (C) The SpyScope, which is the single-use cholangioscope of the SpyGlass DS System.

• 

  Fig. 2 Single-operator cholangioscopy-guided electrohydraulic lithotripsy (EHL). (A) Fluoroscopy image showing an impacted bile duct stone (arrowhead). (B) X-ray image showing SpyScope (arrowhead) inserted into the bile duct. (C) Final cholangiogram showing no residual filling defect. (arrowhead). (D) SpyGlass showing an impacted stone. EHL (arrowheads, EHL probe) is performed under direct visualization. (E) SpyGlass showing the cleared bile duct after EHL. (F) Fragmented bile duct stones are extracted using a stone basket after lithotripsy.

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