Digital single-operator video cholangioscopy in treating refractory biliary stones: a multicenter observational study

Area of Science:

• Gastroenterology
• Endoscopic interventions
• Biliary tract diseases

Background:

• Standard endoscopic treatments for biliary stone disease can be challenging and may fail.
• Difficult biliary stones often require advanced therapeutic approaches.
• Digital single-operator video cholangioscopy (SOVC) is a novel technology for managing complex biliary conditions.

Purpose of the Study:

• To evaluate the efficacy and safety of digital SOVC for treating difficult biliary stones.
• To assess the stone removal rate per procedure and per patient using digital SOVC.
• To compare the effectiveness of laser lithotripsy (LL) and electrohydraulic lithotripsy (EHL) within SOVC-assisted procedures.

Main Methods:

• Retrospective analysis of digital SOVC procedures performed between 2015 and 2018 in two tertiary referral centers.
• Inclusion criteria: patients with prior failed standard endoscopic treatment and SOVC-assisted stone treatment (EHL or LL).
• Primary endpoint: stone removal rate per procedure and per patient.

Main Results:

• Digital SOVC-assisted treatment was successful in 95% of 60 patients (75 examinations).
• Complete stone removal was achieved in 67% of procedures; 15% required multiple sessions.
• LL and EHL showed similar complete stone removal rates (66% vs. 68%, p=0.87).
• Complications (cholangitis, pancreatitis) occurred in 16% of examinations, mostly mild to moderate.

Conclusions:

• Digital SOVC-assisted biliary stone treatment is highly effective for difficult cases, potentially representing a new standard of care.
• The procedure demonstrates significant success rates even in complex biliary stone disease.
• Observed complications were generally mild to moderate, reflecting the complexity of treated cases.