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Surgical Endoscopy

, Volume 30, Issue 3, pp 1249–1254 | Cite as

Effectiveness of peroral direct cholangioscopy using an ultraslim endoscope for the treatment of hepatolithiasis in patients with hepaticojejunostomy (with video)

  • Kazuyuki MatsumotoEmail author
  • Koichiro Tsutsumi
  • Hironari Kato
  • Yutaka Akimoto
  • Daisuke Uchida
  • Takeshi Tomoda
  • Naoki Yamamoto
  • Yasuhiro Noma
  • Shigeru Horiguchi
  • Hiroyuki Okada
  • Kazuhide Yamamoto
Dynamic Manuscript

Abstract

Background

Hepatolithiasis is a postoperative complication of hepaticojejunostomy (HJ) performed for various pancreatobiliary diseases. Hepatolithiasis can cause repeated cholangitis. Complete stone removal and bile stasis elimination are therefore necessary. Here, we evaluated the effectiveness of peroral direct cholangioscopy (PDCS) using an ultraslim endoscope for treating hepatolithiasis in HJ patients.

Methods

We studied 14 patients with hepatolithiasis who underwent bowel reconstruction with HJ between April 2012 and May 2014. Diagnostic and therapeutic endoscopic retrograde cholangiography using a short double-balloon enteroscope (DBE) was initially performed. Following stone removal, the DBE was exchanged for an ultraslim endoscope through the balloon overtube for PDCS.

Results

The success rate of PDCS procedure was 85.7 % (12/14). In 5 of 12 (41.7 %) patients with successful PDCS, the residual stones were detected and removed completely using a 5-Fr basket catheter and suction after normal saline irrigation. In the remaining 7 (58.3 %) patients, no residual stone was detected. The median procedure time was 14 min (range 8–36) with no serious postoperative complications. The median follow-up time after PDCS was 21 months (range 5–26), and only 1 patient (8.3 %) had IHBD stone recurrence with an anastomotic stricture.

Conclusions

PDCS using an ultraslim endoscope appears to be useful for detecting and removing residual stones following hepatolithiasis treatment using a DBE. The combined use of a DBE and PDCS may reduce the risk of hepatolithiasis recurrence in HJ patients.

Keywords

Peroral direct cholangioscopy Hepatolithiasis Altered gastrointestinal anatomy Short double-balloon enteroscopy 

Notes

Disclosures

Kazuyuki Matsumoto, Koichiro Tsutsumi, Hironari Kato, Yutaka Akimoto, Daisuke Uchida, Takeshi Tomoda, Naoki Yamamoto, Yasuhiro Noma, Shigeru Horiguchi, Hiroyuki Okada and Kazuhide Yamamoto have no conflicts of interest to disclose.

Supplementary material

The DBE was exchanged for an ultraslim endoscope leaving the overtube with its balloon inflated. The ultraslim endoscope was advanced through the balloon overtube up to the hepaticojejunostomy anastomosis and was directly inserted into the intrahepatic bile duct. Residual stones were detected and extracted using a 5-Fr basket catheter and suction after normal saline irrigation (WMV 7298 kb)

References

  1. 1.
    Cheon YK, Cho YD, Moon JH, Lee JS, Shim CS (2009) Evaluation of long-term results and recurrent factors after operative and nonoperative treatment for hepatolithiasis. Surgery 146:843–853CrossRefPubMedGoogle Scholar
  2. 2.
    Tsutsumi K, Kato H, Muro S, Yamamoto N, Noma Y, Horiguchi S, Harada R, Okada H, Yamamoto K (2014) ERCP using a short double-balloon enteroscope in patients with prior pancreatoduodenectomy: higher maneuverability supplied by the efferent-limb route. Surg Endosc. doi: 10.1007/s00464-014-3889-8 PubMedGoogle Scholar
  3. 3.
    Sakakihara I, Kato H, Muro S, Noma Y, Yamamoto N, Harada R, Horiguchi S, Tsutsumi K, Okada H, Yamamoto K, Sadamori H, Yagi T (2014) Double-balloon enteroscopy for choledochojejunal anastomotic stenosis after hepato-biliary–pancreatic operation. Dig Endosc. doi: 10.1111/den.12332 PubMedGoogle Scholar
  4. 4.
    Shimatani M, Matsushita M, Takaoka M, Koyabu M, Ikeura T, Kato K, Fukui T, Uchida K, Okazaki K (2009) Effective “short” double-balloon enteroscope for diagnostic and therapeutic ERCP in patients with altered gastrointestinal anatomy: a large case series. Endoscopy 41:849–854CrossRefPubMedGoogle Scholar
  5. 5.
    Takaoka M, Shimatani M, Ikeura T, Koyabu M, Kusuda T, Fukata N, Matsushita M, Okazaki K (2009) Diagnostic and therapeutic procedure with a short double-balloon enteroscope and cholangioscopy in a patient with acute cholangitis due to hepatolithiasis. Gastrointest Endosc 70:1277–1279CrossRefPubMedGoogle Scholar
  6. 6.
    Itoi T, Sofuni A, Itokawa F, Kurihara T, Tsuchiya T, Ishii K, Ikeuchi N, Moriyasu F, Kasuya K, Tsuchida A, Kamisawa T, Baron TH (2012) Diagnostic and therapeutic peroral direct cholangioscopy in patients with altered GI anatomy (with video). Gastrointest Endosc 75:441–449CrossRefPubMedGoogle Scholar
  7. 7.
    Koshitani T, Matsuda S, Takai K, Motoyashi T, Nishikata M, Yamashita Y, Kirishima T, Yoshinami N, Shintani H, Yoshikawa T (2012) Direct cholangioscopy combined with double-balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography. World J Gastroenterol 18:3765–3769PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Itoi T, Sofuni A, Itokawa F, Shinohara Y, Moriyasu F, Tsuchida A (2010) Evaluation of residual bile duct stones by peroral cholangioscopy in comparison with balloon-cholangiography. Dig Endosc 22:S85–S89CrossRefPubMedGoogle Scholar
  9. 9.
    Bonnel DH, Fingerhut AL (2012) Percutaneous transhepatic balloon dilatation of benign bilioenteric strictures: long-term results in 110 patients. Am J Surg 203:675–683CrossRefPubMedGoogle Scholar
  10. 10.
    Glas L, Courbiere M, Ficarelli S, Milot L, Mennesson N, Pilleul F (2008) Long-term outcome of percutaneous transhepatic therapy for benign bilioenteric anastomotic strictures. J Vasc Interv Radiol 19:1336–1343CrossRefPubMedGoogle Scholar
  11. 11.
    Fontein DB, Gibson RN, Collier NA, Tse GT, Wang LL, Speer TG, Dowling R, Robertson A, Thomson B, de Roos A (2011) Two decades of percutaneous transjejunal biliary intervention for benign biliary disease: a review of the intervention nature and complications. Insights Imaging 2:557–565PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Kazuyuki Matsumoto
    • 1
    Email author
  • Koichiro Tsutsumi
    • 1
  • Hironari Kato
    • 1
  • Yutaka Akimoto
    • 1
  • Daisuke Uchida
    • 1
  • Takeshi Tomoda
    • 1
  • Naoki Yamamoto
    • 1
  • Yasuhiro Noma
    • 1
  • Shigeru Horiguchi
    • 1
  • Hiroyuki Okada
    • 1
  • Kazuhide Yamamoto
    • 1
  1. 1.Department of Gastroenterology and HepatologyOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan

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