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Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction

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Biliary and pancreatic lithotripsy devices.

, Rabindra R Watson, Mansour A Parsi

Videogie : an Official Video Journal of the American Society for Gastrointestinal Endoscopy

|November 8, 2018

Summary

Lithotripsy effectively treats difficult biliary and pancreatic duct stones. Various methods exist, offering safe and efficient stone fragmentation for improved patient outcomes.

Keywords:

ASGE, American Society for Gastrointestinal Endoscopy C-APCS, Comprehensive Ambulatory Payment Classification CMS, Centers for Medicare and Medicaid Services CPT, Current Procedural Terminology (https://www.asge.org/docs/default-source/education/Technology_Reviews/doc-enteral-nutrition-access-devices.pdf?sfvrsn=4)EHL, electrohydraulic lithotripsy EPBD, endoscopic papillary balloon dilation ERCP, endoscopic retrograde cholangiopancreatography ES, endoscopic sphincterotomy ESWL, extracorporeal shock wave lithotripsy FDA, U.S. Food and Drug Administration FREDDY, frequency-doubled, double-pulse neodymium HCPCS, Healthcare Common Procedure Coding System MAUDE, Manufacturer and User Facility Device Experience ML, mechanical lithotripsy RCT, randomized controlled trial YAG, yttrium aluminum garnet

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Area of Science:

Gastroenterology
Endoscopic Procedures

Background:

Lithotripsy fragments stones in biliary and pancreatic ducts.
Conventional endoscopic removal is suitable for most stones.
Lithotripsy is necessary for large, impacted, or irregular stones.

Purpose of the Study:

Review devices and methods for biliary and pancreatic lithotripsy.
Evaluate the efficacy, safety, and financial aspects of lithotripsy techniques.

Main Methods:

Review of intracorporeal lithotripsy (mechanical, electrohydraulic, laser).
Review of extracorporeal shock-wave lithotripsy (ESWL).
Comparison of techniques including endoscopic papillary balloon dilation (EPBD).

Main Results:

Mechanical lithotripsy (ML) is effective for difficult stones.
Endoscopic papillary balloon dilation (EPBD) may reduce the need for ML and adverse events.
Electrohydraulic lithotripsy (EHL) and laser lithotripsy are effective but often require specialized centers.
ESWL is effective but may involve increased costs and coordination.

Conclusions:

Multiple lithotripsy techniques exist with varying ease of use, generalizability, and cost.
Lithotripsy is a safe and effective treatment for challenging biliary and pancreatic duct stones.