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Erschienen in:
11.08.2023 | Research letter
Efficacy and safety of digital single-operator cholangioscopy-guided laser lithotripsy for remnant cystic duct stone—A single tertiary care center experience
Erschienen in: Indian Journal of Gastroenterology | Ausgabe 4/2024
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Cystic duct stone (CDS) is considered difficult bile duct stone to manage by conventional endoscopic retrograde cholangiopancreatography (ERCP) [1]. CDS can present with biliary colic, obstructive jaundice and Mirizzi syndrome. The incidence of remnant cystic duct stone has increased (16%) after the widespread use of laparoscopic cholecystectomy [2]. CDS after cholecystectomy poses unique diagnostic and therapeutic challenge with limited treatment options, including surgery. Surgery can be dicey in this situation due to scarring and adhesions from the previous surgery and may require conversion of laparoscopic to open surgery in 17% [3]. Although ERCP is an alternative option to surgery, cannulation and stone retrieval from the cystic duct with conventional methods can be technically challenging [4]. Cholangioscopy-guided laser lithotripsy has been shown to be a safe and effective modality for difficult bile duct stones, cystic duct calculi and Mirizzi syndrome [5‐7]. However, there is a dearth of data on the role of cholangioscopy in CDS after cholecystectomy. In this study, we aimed at seeing the feasibility and effectivity of cholangioscopy-guided laser lithotripsy in remnant CDS (Table 1).
Table 1
Peri-procedural characteristics of laser lithotripsy of remnant cystic duct stones
|
No. of patients
|
22
|
|---|---|
|
Age in years, median (range)
|
45.5 (26–71)
|
|
Gender, male: female
|
13:9
|
|
ERCP for CBD stone prior to cholecystectomy
|
17
|
|
Cholecystectomy
|
|
|
Total
|
20
|
|
Partial
|
2
|
|
Diagnosis of cystic duct stone post-cholecystectomy
|
|
|
At the time of CBD stent removal
|
17
|
|
Symptomology
|
5 (Biliary colic-3, jaundice-1 and cholangitis-1)
|
|
Cystic duct stone size into mm, median (range)
|
14 (6–20)
|
|
No. of cystic duct stone
|
|
|
Single stone
|
20
|
|
Two/three stones
|
2
|
|
Balloon sphincteroplasty performed/extended before lithotripsy
|
12 (10 mm n = 4, 12 mm n = 6 and 15 mm n = 2)
|
|
Temporary biliary SEMS placement for distal CBD narrowing before cholangioscope insertion
|
2
|
|
Mechanical lithotripsy before laser lithotripsy
|
9
|
|
Technical success of cystic duct cannulation
|
18
|
|
Complete cystic duct clearance in first session of laser lithotripsy
|
19
|
|
Sessions of lithotripsy
|
|
|
1 session
|
19
|
|
2 sessions
|
1
|
|
Duration of laser applied in minutes, median (range)
|
20 (10–35)
|
|
Whole procedure duration in minutes, median (range)
|
57.5 (30–90)
|
|
Post-laser lithotripsy stenting
|
|
|
CBD stenting
|
22 (1 stent n = 21 and 2 stents n = 1)
|
|
Both cystic and CBD stenting
|
3
|
|
Adverse events
|
|
|
Mild
|
Cholangitis-1, mild acute pancreatitis-1
|
|
Moderate
|
Pancreatitis-1
|
|
Average duration of stent removal on follow-up, weeks
|
4 (1–8)
|
|
Follow-up, months in median (range)
|
17 (3–54)
|
