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Digital cholangioscopy-assisted, direct visualization-guided, radiation-free, endoscopic retrograde intervention for cholelithiasis: technical feasibility, efficacy, and safety

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Abstract

Background

Nonradiation, digital cholangioscope (DCS)-assisted endoscopic intervention for cholelithiasis has not been widely performed. For this study, we aimed to report the feasibility, efficacy, and safety of an established DCS-guided lithotomy procedure.

Methods

Data relating to biliary exploration, stone clearance, adverse events, and follow-up were obtained from 289 patients. The choledocholithiasis-related outcomes via the DCS-guided procedure were subsequently compared to those via conventional endoscopic retrograde cholangiopancreatography (ERCP).

Results

Biliary access was achieved in 285 patients. The technical success rate for the exploration of the common bile duct, the cystic stump, the hilar ducts, and secondary radicals was 100%. Moreover, the success rates were 98.4%, 61.7%, and 20.7%, for the exploration of the cystic duct, complete cystic duct, and gallbladder, respectively. Suspicious or confirmed suppurative cholecystitis, cholesterol polyps, and hyperplastic polyps were detected in 42, 23, and 5 patients, respectively. Stone clearance was achieved in one session in 285 (100%), 11 (100%), 13 (100%), 7 (100%), 6 (100%), and 3 (14.3%) patients with choledocholithiasis and hepatolithiasis, cystic duct stump stones, nondiffuse located intrahepatic lithiasis, a single cystic duct stone, a single gallbladder stone, and diffuse located intrahepatic lithiasis, respectively. Complete stone clearance for diffuse intrahepatic lithiasis was achieved in 19 (90.5%) patients, and fractioned re-lithotomy was performed in 16 (76.2%) patients. One patient developed mild acute cholangitis, and 12 developed mild pancreatitis. Stones recurred in one patient. Compared with conventional ERCP, DCS-guided lithotomy has the advantages of clearing difficult-to-treat choledocholithiasis and revealing concomitant biliary lesions, and this technique has fewer complications and a decreased risk of stone recurrence.

Conclusions

The technical profile, efficacy, and safety of nonradiation-guided and DCS-guided lithotomy are shown in this study. We provide a feasible modality for the endoscopic removal of cholelithiasis.

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Acknowledgements

We thank Dr. Xilong Ou, Dazhong Cao and Juan Liu for performing conventional ERCP for the treatment of choledocholithiasis.

Funding

This work was funded by the Program of Nanjing Healthy Commission (YKK22276).

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Authors and Affiliations

  1. Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China

    Yadong Feng, Yan Liang, Yang Liu, Shuaijing Huang, Lihua Ren & Ruihua Shi

  2. Department of Gastroenterology, Previously School of Medicine, Humanity Hospital, Southeast University, 3777 Yuexian Road, Xiamen, 361006, China

    Yinqiu Zhang

  3. Department of Translational Research, Nanjing Microtech Medical Technology Co. Ltd., 10 Gaoke 3rd Road, Nanjing, 210018, China

    Xiaojun Ma

  4. Department of Gastroenterology, Lianshui People’s Hospital, 6 Hongri Road, Lianshui, 223400, China

    Yadong Feng & Aijun Zhou

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  1. Yadong Feng
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  2. Yan Liang
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  3. Yang Liu
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  9. Ruihua Shi
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Corresponding authors

Correspondence to Yadong Feng, Aijun Zhou or Ruihua Shi.

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Disclosures

Xiaojun Ma is an employee of Nanjing Microtech Medical Technology Co. Ltd. However, he is one of the key members who designed and modified the slim basket. He has no financial interest in this research and did not prepare the manuscript. Yadong Feng, Yan Liang, Yang Liu, Yinqiu Zhang, Shuaijing Huang, Lihua Ren, Xiaojun Ma, Aijun Zhou, and Ruihua Shi have no conflicts of interest or financial ties to disclose.

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Feng, Y., Liang, Y., Liu, Y. et al. Digital cholangioscopy-assisted, direct visualization-guided, radiation-free, endoscopic retrograde intervention for cholelithiasis: technical feasibility, efficacy, and safety. Surg Endosc 38, 1637–1646 (2024). https://doi.org/10.1007/s00464-024-10684-3

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