Implementation of Direct Peroral Cholangioscopy for Common Bile Duct Stones

Jonathan Leunbach, MD, Jan M Krzak, MD, Einar Pahle, MD, PhD. Department of Surgery, Viborg Hospital, Viborg, Denmark.

To evaluate the process and the initial results of implementing Direct Peroral Cholangioscopy (DPC) as a new treatment modality in patients with common bile duct stones refractory to retrieval by conventional Endoscopic Retrograde
Cholangiopancreatography (ERCP).
Retrospective analysis of 5 cases, which were performed in secondary referral center during a period of one year from August 2012 to August 2013, with a special focus on logistic and technical problems associated with introduction of Direct Peroral Cholangioscopy (DPC). Indication for the procedure was common bile duct stones on which the previous attempts of extraction by ERCP have failed.
A subsequent cholangioscopy was preformed using a nasal gastroscope over a guidewire, with the possibility of laser lithotripsy.
All procedures were preformed by an very experienced endoscopist.
In all cases the common bile duct was intubated successfully with the nasal gastroscope.
Mean age of the patients was 71 years [51-84], and the mean procedure time was 121 min. [50-215].
In 4 out of 5 patients clearance of the common bile duct was achieved. One patient was re-ferred to a tertiary referral center because of a stenosis of the CBD.
One patient required two procedures before a clearance of CBD stones was achieved, and one had an additional ERCP with extraction of stone remnants.
No severe complications occurred.
An analysis of logistic and technical problems associated with introduction of DPC, a review of the results with a video presentation and a review of literature, as well as advantages and complications will be presented.
DPC appears to be a feasible, useful and safe, however very demanding modality for the treatment of difficult common bile duct stones. It can be implemented quickly in the hands of an experienced endoscopist.

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