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[Peroral and transhepatic cholangioscopy].

W Schmitt1, H von Sanden, W Wegerle

  • 1Medizinische Abteilung, Krankenhaus Neuperlach, München.

Leber, Magen, Darm
|May 1, 1991
PubMed
Summary

Intracorporeal shockwave lithotripsy via cholangioscopy effectively treats difficult common bile duct (CBD) stones, even after mechanical lithotripsy failure. This minimally invasive technique achieved complete stone clearance in all patients without serious complications.

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Area of Science:

  • Gastroenterology and Hepatology
  • Minimally Invasive Procedures
  • Endoscopic Interventions

Context:

  • Cholangioscopy offers peroral and transhepatic access for diagnosing and treating biliary conditions.
  • Tumor strictures and stenoses of the common bile duct (CBD) present diagnostic challenges.
  • Therapeutic cholangioscopy, particularly with intracorporeal shockwave lithotripsy, addresses difficult CBD stones.

Purpose:

  • To evaluate the efficacy and safety of intracorporeal shockwave lithotripsy (ISWL) during cholangioscopy for treating common bile duct (CBD) stones.
  • To assess ISWL as an alternative when conventional methods like mechanical lithotripsy during ERCP have failed.
  • To determine the success rate of ISWL in patients with altered anatomy, precluding standard ERCP.

Summary:

  • A total of 23 patients with 58 CBD stones (median diameter 20 mm) were treated using cholangioscopy with ISWL (electrohydraulic principle) under direct visual control.
  • The mother-baby technique was employed, successfully treating stones in 17 patients (40 stones) where mechanical lithotripsy had previously failed.
  • Transhepatic cholangioscopy with ISWL was performed in 6 patients with operated stomachs, treating 18 stones inaccessible via conventional ERCP.

Impact:

  • Intracorporeal shockwave lithotripsy during cholangioscopy provides a highly effective solution for complex CBD stones.
  • This technique offers a viable treatment option for patients with challenging stones or altered anatomy unsuitable for standard ERCP.
  • Achieved complete stone clearance in all cases, demonstrating a high safety profile with no serious complications.

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