Digital single-operator cholangioscopy in treating difficult biliary stones: results from a multicenter experience

Area of Science:

• Gastroenterology
• Endoscopic interventions
• Biliary tract diseases

Background:

• Standard endoscopic treatment for biliary stones has a failure rate of up to 10%, necessitating more invasive procedures.
• Difficult biliary stones pose a challenge in clinical practice, often requiring advanced endoscopic techniques.
• Digital single-operator cholangioscopy (D-SOC) has emerged as a potential alternative for complex cases.

Purpose of the Study:

• To evaluate the efficacy and safety of D-SOC for treating difficult biliary stones.
• To assess D-SOC in patients who previously failed conventional endoscopic methods.
• To determine the stone clearance rate per procedure and per patient using D-SOC.

Main Methods:

• A multicenter retrospective study using prospectively-collected data.
• Inclusion of patients with failed standard endoscopic treatment and subsequent D-SOC intervention.
• Utilized electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL) with D-SOC for stone fragmentation and removal.

Main Results:

• Complete biliary stone removal was achieved in 67.7% of procedures and 100% of patients.
• Incomplete stone removal occurred in 35.4% of procedures, with partial removal in 36.3% of those cases.
• Both EHL and LL showed similar efficacy, with one mild adverse event (cholangitis) reported.

Conclusions:

• Digital D-SOC is highly effective for treating difficult biliary stones, especially after conventional treatment failure.
• D-SOC demonstrates a high safety profile with minimal adverse events.
• D-SOC may represent a new standard of care for complex biliary stone management.