Peroral cholangioscopy for management of residual stones after retrograde chalangiopancreatography / 中华消化内镜杂志

ABSTRACT

Objective To investigate the diagnostic and therapeutic value of peroral cholangioscopy for residual stones after retrograde chalangiopancreatography (ERCP).Methods The soft-tipped guidewire (0.021in) was linked to 3-0 silk thread on the front of extraction balloon catheter outside as a guide device.After retrograde chalangiopancreato-graphy (ERCP) for common bile duct stones,extraction balloon with the guide device was sent to intrahepatic bile duct by duodenoscopy,and residual stones were observed and removed with a stone basket directly under ultrathin upper endoscope if the residual stones were small ; if the stones were large,they were crushed with electrohydraulic lithotripsy before being removed.Results The ultrathin upper endoscope were successfully inserted into hilar bile duct in 42 cases of 46 patients,and failed in 4 cases,and the success rate of insertion was 91.3％.The mean time was 11.3 min from the mouth into hilar bile duct.Stones were found larger than 4 mm in diameter in 6 of 42 patients,and stone residual rate was 14.3％.The biggest stone was 10 mm× 12 mm in diameter.Stones were found in in 2 of 27 patients after ERCP,and the stone residual rate was 7.4％.Stones were found in 4 of 15 patients after ERCP basket lithotripsy,and the stone residual rate was 26.7％.Stones were removed directly in 5 in 6 cases with extraction basket,they were crushed in 1 case by electrohydraulic lithotripsy and then removed with basket.No serious complications were observed.Conclusion The application of peroral cholangioscopy using an ultrathin upper endoscope is feasible.The method is a useful endoscopic procedure for extraction of residual stones,which helps to avoid repeated treatment.