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Background <p>The management of biliary stones in patients with postsurgical anatomical variations can be particularly challenging. Percutaneous cholangioscopy (PC) with electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL) has been proposed as a&#xa0;treatment approach. However, the requirement for a&#xa0;stable and wide biliary tract, combined with the limitations of standard cholangioscopes—such as restricted bilateral movements and limited operative angles—can reduce success rates and increase the risk of adverse events. This study aimed to evaluate the feasibility, efficacy, and safety of PC with EHL using a&#xa0;single-operator, small-caliber cholangioscope (SpyGlass™ DS System, Boston Scientific, Natick, MA, USA).</p> Materials and methods <p>Data from patients with postsurgical altered anatomy who underwent PC with EHL at two Italian referral centers were retrospectively reviewed. Demographic data, type of anatomical alteration, technical success, complications, and recurrence rates were collected and analyzed.</p> Results <p>Technical success was achieved in 37&#xa0;out of 38&#xa0;patients (97.3%) across a&#xa0;total of 41&#xa0;procedures. Complications occurred in 6&#xa0;out of 41&#xa0;procedures (14.6%): 1&#xa0;case (2.6%) of severe bleeding requiring embolization, 3&#xa0;cases (7.3%) of mild cholangitis, and 2&#xa0;cases (4.8%) of mild pancreatitis. Five patients (15.6%) experienced stone recurrence within 24&#xa0;months of discharge. Bile duct strictures were identified as a&#xa0;significant risk factor for recurrence (<i>p</i> = 0.01).</p> Conclusion <p>Our results show that PC with EHL using the SpyGlass™ DS System appears to be a&#xa0;feasible and safe technique with high technical success and low complication rates. It may be considered a&#xa0;first-line approach in referral centers for patients with postsurgical anatomical alterations, potentially reducing the need for surgical intervention.</p>

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Percutaneous transhepatic cholangioscopy and lithotripsy using a single-operator cholangioscope for the management of biliary stones in postoperative anatomical variations

  • 期刊论文

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  • 发表日期：

    2025年9月11日

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  • Pavlos Antypas,
  • Gianfranco Fanello,
  • Mario Corona,
  • Roberto Cirocchi,
  • Gabriele Marinozzi,
  • Massimiliano Allegritti,
  • Fausto Fiocca

摘要

Background

The management of biliary stones in patients with postsurgical anatomical variations can be particularly challenging. Percutaneous cholangioscopy (PC) with electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL) has been proposed as a treatment approach. However, the requirement for a stable and wide biliary tract, combined with the limitations of standard cholangioscopes—such as restricted bilateral movements and limited operative angles—can reduce success rates and increase the risk of adverse events. This study aimed to evaluate the feasibility, efficacy, and safety of PC with EHL using a single-operator, small-caliber cholangioscope (SpyGlass™ DS System, Boston Scientific, Natick, MA, USA).

Materials and methods

Data from patients with postsurgical altered anatomy who underwent PC with EHL at two Italian referral centers were retrospectively reviewed. Demographic data, type of anatomical alteration, technical success, complications, and recurrence rates were collected and analyzed.

Results

Technical success was achieved in 37 out of 38 patients (97.3%) across a total of 41 procedures. Complications occurred in 6 out of 41 procedures (14.6%): 1 case (2.6%) of severe bleeding requiring embolization, 3 cases (7.3%) of mild cholangitis, and 2 cases (4.8%) of mild pancreatitis. Five patients (15.6%) experienced stone recurrence within 24 months of discharge. Bile duct strictures were identified as a significant risk factor for recurrence (p = 0.01).

Conclusion

Our results show that PC with EHL using the SpyGlass™ DS System appears to be a feasible and safe technique with high technical success and low complication rates. It may be considered a first-line approach in referral centers for patients with postsurgical anatomical alterations, potentially reducing the need for surgical intervention.