Advanced ERCP techniques for the extraction of complex biliary stones

a single referral center’s 12-year experience

Nicholas G. Brown, Joel Camilo, Eric Nordstrom, Roy D. Yen, Norio Fukami, Brian C. Brauer, Sachin Wani, Stuart K. Amateau, Augustin R. Attwell, Raj J. Shah

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: Advanced ERCP techniques (AETs) for difficult biliary stones include peroral cholangioscopy (POC) with electrohydraulic/laser lithotripsy (EHL/LL), endoscopic papillary large balloon dilation (EPLBD) and mechanical lithotripsy (ML). We assess the efficacy of AETs. Methods: A retrospective query for AETs. Primary outcome: Complete duct clearance. Secondary outcome: Complete duct clearance by technique. Statistical Analysis version 9.3 (SAS Inc., Cary, NC). Results: From 1/00 to 10/12, 349 patients were identified of which 222 (80% had prior ERCPs) had AETs. 211 with sufficient follow-up underwent 295 ERCPs; 280 of which were AET’s. Index AETs: POC with EHL/LL (n = 46/211, 22%), ML (n = 84/211, 40%), EPLBD with mean balloon size of 11.5 ± 1.7 mm (n = 39/211, 18%) and combination AETs (n = 42/211, 20%). Stone characteristics: 76% had ≥1 stone, 81% extrahepatic and 32% had strictures. Number of stones (mean 2.5 and range 1–20) did not differ among groups. EPLBD had higher percentage (95%) of extrahepatic stones (p =.0003). The ‘Combination’ and ‘POC’ groups had larger stones (mean 17.7 mm ±6.4 and 16.8 mm ±6.1, respectively; p <.001). Complete clearance: 209/211 (99%) at index AET 167/211 (79%) or after mean of 2.5 ± 0.7 AETs in 42/211 (20%). Partial clearance: 2/211 (1%). Clearance at index AETs was higher with EPLBD (90%, p =.014). Adverse Events: 7/280 (2.5%). Conclusions: AETs achieved clearance in 99%. EPLBD had higher clearance at index AET likely owing to higher extrahepatic stones. Larger stones, but not number, were associated with increased combination AETs and total ERCPs.

Original languageEnglish (US)
Pages (from-to)626-631
Number of pages6
JournalScandinavian Journal of Gastroenterology
Volume53
Issue number5
DOIs
StatePublished - May 4 2018
Externally publishedYes

Fingerprint

Endoscopic Retrograde Cholangiopancreatography
Referral and Consultation
Dilatation
Laser Lithotripsy
Lithotripsy

Keywords

  • biliary stones
  • cholangioscopy
  • Choledocholithiasis
  • ERCP
  • lithotripsy

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Advanced ERCP techniques for the extraction of complex biliary stones : a single referral center’s 12-year experience. / Brown, Nicholas G.; Camilo, Joel; Nordstrom, Eric; Yen, Roy D.; Fukami, Norio; Brauer, Brian C.; Wani, Sachin; Amateau, Stuart K.; Attwell, Augustin R.; Shah, Raj J.

In: Scandinavian Journal of Gastroenterology, Vol. 53, No. 5, 04.05.2018, p. 626-631.

Research output: Contribution to journalArticle

Brown, NG, Camilo, J, Nordstrom, E, Yen, RD, Fukami, N, Brauer, BC, Wani, S, Amateau, SK, Attwell, AR & Shah, RJ 2018, 'Advanced ERCP techniques for the extraction of complex biliary stones: a single referral center’s 12-year experience', Scandinavian Journal of Gastroenterology, vol. 53, no. 5, pp. 626-631. https://doi.org/10.1080/00365521.2018.1441434
Brown, Nicholas G. ; Camilo, Joel ; Nordstrom, Eric ; Yen, Roy D. ; Fukami, Norio ; Brauer, Brian C. ; Wani, Sachin ; Amateau, Stuart K. ; Attwell, Augustin R. ; Shah, Raj J. / Advanced ERCP techniques for the extraction of complex biliary stones : a single referral center’s 12-year experience. In: Scandinavian Journal of Gastroenterology. 2018 ; Vol. 53, No. 5. pp. 626-631.
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abstract = "Objectives: Advanced ERCP techniques (AETs) for difficult biliary stones include peroral cholangioscopy (POC) with electrohydraulic/laser lithotripsy (EHL/LL), endoscopic papillary large balloon dilation (EPLBD) and mechanical lithotripsy (ML). We assess the efficacy of AETs. Methods: A retrospective query for AETs. Primary outcome: Complete duct clearance. Secondary outcome: Complete duct clearance by technique. Statistical Analysis version 9.3 (SAS Inc., Cary, NC). Results: From 1/00 to 10/12, 349 patients were identified of which 222 (80{\%} had prior ERCPs) had AETs. 211 with sufficient follow-up underwent 295 ERCPs; 280 of which were AET’s. Index AETs: POC with EHL/LL (n = 46/211, 22{\%}), ML (n = 84/211, 40{\%}), EPLBD with mean balloon size of 11.5 ± 1.7 mm (n = 39/211, 18{\%}) and combination AETs (n = 42/211, 20{\%}). Stone characteristics: 76{\%} had ≥1 stone, 81{\%} extrahepatic and 32{\%} had strictures. Number of stones (mean 2.5 and range 1–20) did not differ among groups. EPLBD had higher percentage (95{\%}) of extrahepatic stones (p =.0003). The ‘Combination’ and ‘POC’ groups had larger stones (mean 17.7 mm ±6.4 and 16.8 mm ±6.1, respectively; p <.001). Complete clearance: 209/211 (99{\%}) at index AET 167/211 (79{\%}) or after mean of 2.5 ± 0.7 AETs in 42/211 (20{\%}). Partial clearance: 2/211 (1{\%}). Clearance at index AETs was higher with EPLBD (90{\%}, p =.014). Adverse Events: 7/280 (2.5{\%}). Conclusions: AETs achieved clearance in 99{\%}. EPLBD had higher clearance at index AET likely owing to higher extrahepatic stones. Larger stones, but not number, were associated with increased combination AETs and total ERCPs.",
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T2 - a single referral center’s 12-year experience

AU - Brown, Nicholas G.

AU - Camilo, Joel

AU - Nordstrom, Eric

AU - Yen, Roy D.

AU - Fukami, Norio

AU - Brauer, Brian C.

AU - Wani, Sachin

AU - Amateau, Stuart K.

AU - Attwell, Augustin R.

AU - Shah, Raj J.

PY - 2018/5/4

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N2 - Objectives: Advanced ERCP techniques (AETs) for difficult biliary stones include peroral cholangioscopy (POC) with electrohydraulic/laser lithotripsy (EHL/LL), endoscopic papillary large balloon dilation (EPLBD) and mechanical lithotripsy (ML). We assess the efficacy of AETs. Methods: A retrospective query for AETs. Primary outcome: Complete duct clearance. Secondary outcome: Complete duct clearance by technique. Statistical Analysis version 9.3 (SAS Inc., Cary, NC). Results: From 1/00 to 10/12, 349 patients were identified of which 222 (80% had prior ERCPs) had AETs. 211 with sufficient follow-up underwent 295 ERCPs; 280 of which were AET’s. Index AETs: POC with EHL/LL (n = 46/211, 22%), ML (n = 84/211, 40%), EPLBD with mean balloon size of 11.5 ± 1.7 mm (n = 39/211, 18%) and combination AETs (n = 42/211, 20%). Stone characteristics: 76% had ≥1 stone, 81% extrahepatic and 32% had strictures. Number of stones (mean 2.5 and range 1–20) did not differ among groups. EPLBD had higher percentage (95%) of extrahepatic stones (p =.0003). The ‘Combination’ and ‘POC’ groups had larger stones (mean 17.7 mm ±6.4 and 16.8 mm ±6.1, respectively; p <.001). Complete clearance: 209/211 (99%) at index AET 167/211 (79%) or after mean of 2.5 ± 0.7 AETs in 42/211 (20%). Partial clearance: 2/211 (1%). Clearance at index AETs was higher with EPLBD (90%, p =.014). Adverse Events: 7/280 (2.5%). Conclusions: AETs achieved clearance in 99%. EPLBD had higher clearance at index AET likely owing to higher extrahepatic stones. Larger stones, but not number, were associated with increased combination AETs and total ERCPs.

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