Clinical Endoscopy

Successful removal of remnant cystic duct stump stone using single-operator cholangioscopy-guided electrohydraulic lithotripsy: two case reports: Sung Hyeok Ryou, Hong Ja Kim; Clin Endosc 2023;56(3):375-380. Published online January 5, 2023; DOI: https://doi.org/10.5946/ce.2021.273

Cholecystectomy is the best method for treating gallstone diseases. However, 10%–30% of patients who undergo a cholecystectomy continue to complain of upper abdominal pain, dyspepsia, or jaundice—this is referred to as postcholecystectomy syndrome. Cystic duct stump stones are a troublesome cause of postcholecystectomy syndrome. Conventionally, surgery is mainly performed to remove cystic duct stump stones. However, repeated surgery can cause complications, such as postoperative bleeding, biliary injury, and wound infection. As an alternative method of surgery, endoscopic retrograde cholangiopancreatography is sometimes used to remove cystic duct stump stones, although the success rate is not high due to technical difficulties. Recently, peroral cholangioscopy, which can directly observe the bile duct, has been suggested as an alternative method. We report two cases in which a cystic duct stump stone was successfully removed via a single-operator cholangioscopy, after failure with an endoscopic retrograde cholangiopancreatography.

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Clinical perspectives on post-cholecystectomy syndrome: a narrative review
Changjin Nam, Jun Suh Lee, Ji Su Kim, Tae Yoon Lee, Young Chul Yoon
Annals of Medicine.2025;[Epub] CrossRef
Holmium Laser Lithotripsy in the Management of Difficult Biliary and Cystic Ductal Stones – A Case Series
Amit Kumar, Harindra Kumar Goje, Nimesh Kumar Tarway, Vivek Hande
Journal of Marine Medical Society.2024;[Epub] CrossRef
Laparoscopic management of remnant gall bladder with stones: Lessons from a tertiary care centre's experience
Gilbert Samuel Jebakumar, Jeevanandham Muthiah, Loganathan Jayapal, R. Santhosh Kumar, Siddhesh Tasgaonkar, K.S. Santhosh Anand, J.K.A. Jameel, Sudeepta Kumar Swain, K.J. Raghunath, Prasanna Kumar Reddy, Tirupporur Govindaswamy Balachandar
Laparoscopic, Endoscopic and Robotic Surgery.2024; 7(1): 27. CrossRef
A remnant cystic duct presenting as a duodenal subepithelial tumor
Gwang Ha Kim, Dong Chan Joo
Clinical Endoscopy.2024; 57(2): 268. CrossRef

7,490 View
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Cracking Difficult Biliary Stones: Phonthep Angsuwatcharakon, Rungsun Rerknimitr; Clin Endosc 2021;54(5):660-668. Published online March 16, 2021; DOI: https://doi.org/10.5946/ce.2020.256-IDEN

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Apart from difficult biliary cannulation, biliary stone removal is considered one of the hurdles in endoscopic retrograde cholangiopancreatography. Generally, simple common bile duct (CBD) stones can be removed either with an extraction balloon or a basket. However, there are difficult stones that cannot be removed using these standard methods. The most difficult stones are large CBD stones and impacted stones in a tapering CBD. A few decades ago, mechanical lithotripsy was usually required to manage these stones. At present, endoscopic papillary large balloon dilation (EPLBD) of the biliary orifice has become the gold standard for large CBD stones up to 1.5 cm. EPLBD can reduce the procedural time by shortening the stone removal process. It can also save the cost of the devices, especially multiple baskets, used in mechanical lithotripsy. Unfortunately, very large CBD stones, stones impacted in a tapering CBD, and some intrahepatic duct stones still require lithotripsy. Peroral cholangioscopy provides direct visualization of the stone, which helps the endoscopist perform a probe-based lithotripsy either with an electrohydraulic probe or a laser probe. This technique can facilitate the management of difficult CBD stones with a high success rate and save procedural time without significant technical complications.

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Cholangioscopy as a rescue for a post-cholecystectomy adherent stone formed around a migrated surgical clip in the common bile duct
Chukwunonso Ezeani, Samuel O. Igbinedion, Kwabena Asafo-Agyei, Erik A. Holzwanger, Sultan Mahmood, Mandeep S. Sawhney, Tyler M. Berzin, Moamen Gabr, Douglas K. Pleskow
VideoGIE.2024; 9(5): 241. CrossRef
The role and designation of emergency choledochoscopy in the laparoscopic treatment of patients with complicated choledocholithiasis
M.V. Maksymenko, V.V. Volkovetskii
EMERGENCY MEDICINE.2024; 20(6): 489. CrossRef
Endoscopic Treatment of Large Bile Duct Stones: A Systematic Review and Network Meta-Analysis
Antonio Facciorusso, Paraskevas Gkolfakis, Daryl Ramai, Georgios Tziatzios, Janice Lester, Stefano Francesco Crinò, Leonardo Frazzoni, Ioannis S. Papanikolaou, Marianna Arvanitakis, Daniel Blero, Arnaud Lemmers, Pierre Eisendrath, Lorenzo Fuccio, Konstant
Clinical Gastroenterology and Hepatology.2023; 21(1): 33. CrossRef
First experience of endoscopic treatment of large biliary stones by contact lithotripsy
L.L. Generdukayev, D.A. Blagovestnov, Yu.S. Teterin, P.A. Yartsev
Endoscopic Surgery.2023; 29(2): 51. CrossRef
Percutaneous transhepatic cholangioscopy for benign and malignant biliary disease using a novel short single-operator cholangioscope
A. K. Uribe Rivera, B. Seeliger, C. A. Saldivar, E. Houghton, F. Rodríguez, P. Acquafresca, M. Palermo, M. E. Giménez
Surgical Endoscopy.2023; 37(10): 7774. CrossRef
Outcomes of balloon vs basket catheter for clearance of choledocholithiasis: a systematic review and meta-analysis
Ruchi Sharma, Vikram Sharma, Umang Singhal, Madhusudhan Sanaka
Endoscopy International Open.2022; 10(11): E1447. CrossRef

6,295 View
268 Download
3 Web of Science
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Minimally Invasive Approach Using Digital Single-Operator Peroral Cholangioscopy-Guided Electrohydraulic Lithotripsy and Endoscopic Nasogallbladder Drainage for the Management of High-Grade Mirizzi Syndrome: Hyung Ku Chon, Chan Park, Tae Hyeon Kim; Clin Endosc 2021;54(6):930-934. Published online February 18, 2021; DOI: https://doi.org/10.5946/ce.2021.015

Abstract PDF PubReader ePub

Mirizzi syndrome is a rare complication of gallbladder disease that can be difficult to treat. In particular, endoscopic treatment often fails because of the inability to access or to capture the impacted cystic duct stone. We report a case of Mirizzi syndrome grade III that was successfully managed by digital single-operator peroral cholangioscopy-guided electrohydraulic lithotripsy with endoscopic nasogallbladder drainage and interval laparoscopic cholecystectomy. Based on our experience, digital single-operator peroral cholangioscopy-guided electrohydraulic lithotripsy with endoscopic nasogallbladder drainage is a feasible minimally invasive approach for the management of high-grade Mirizzi syndrome.

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Difficult Biliary Stones: A Comprehensive Review of New and Old Lithotripsy Techniques
Edoardo Troncone, Michelangela Mossa, Pasquale De Vico, Giovanni Monteleone, Giovanna Del Vecchio Blanco
Medicina.2022; 58(1): 120. CrossRef
Endoscopic management of cystic duct stones and Mirizzi’s syndrome: experience at an academic medical center
Rishi Pawa, Robert Dorrell, Swati Pawa
Endoscopy International Open.2022; 10(01): E135. CrossRef
Mirizzi Syndrome Type IV Successfully Treated with Peroral Single-operator Cholangioscopy-guided Electrohydraulic Lithotripsy: A Case Report with Literature Review
Hirokazu Kawai, Toshifumi Sato, Masaaki Natsui, Kotaro Watanabe, Ryosuke Inoue, Mayuki Kimura, Kazumi Yoko, Syun-ya Sasaki, Masashi Watanabe, Taku Ohashi, Akihiro Tsukahara, Norio Tanaka, Yoshihisa Tsukada
Internal Medicine.2022; 61(23): 3513. CrossRef
Quality of life of treated patients with Mirizi syndrome
F. M. Pavuk
Klinicheskaia khirurgiia.2021; 88(1-2): 69. CrossRef
A Stone in Remnant Cystic Duct Causing Mirizzi Syndrome Following Laparoscopic Cholecystectomy
Min Jae Yang, Do Hyun Park
Clinical Endoscopy.2021; 54(5): 777. CrossRef

4,146 View
109 Download
4 Web of Science
5 Crossref

Electrohydraulic Lithotripsy of an Impacted Enterolith Causing Acute Afferent Loop Syndrome: Young Sin Cho, Tae Hoon Lee, Soon Oh Hwang, Sunhyo Lee, Yunho Jung, Il-Kwun Chung, Sang-Heum Park, Sun-Joo Kim; Clin Endosc 2014;47(4):367-370. Published online July 28, 2014; DOI: https://doi.org/10.5946/ce.2014.47.4.367

Abstract PDF PubReader ePub

Afferent loop syndrome caused by an impacted enterolith is very rare, and endoscopic removal of the enterolith may be difficult if a stricture is present or the normal anatomy has been altered. Electrohydraulic lithotripsy is commonly used for endoscopic fragmentation of biliary and pancreatic duct stones. A 64-year-old man who had undergone subtotal gastrectomy and gastrojejunostomy presented with acute, severe abdominal pain for a duration of 2 hours. Initially, he was diagnosed with acute pancreatitis because of an elevated amylase level and pain, but was finally diagnosed with acute afferent loop syndrome when an impacted enterolith was identified by computed tomography. We successfully removed the enterolith using direct electrohydraulic lithotripsy conducted using a transparent cap-fitted endoscope without complications. We found that this procedure was therapeutically beneficial.

Citations

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Migrated Pancreaticojejunal Stent Forming a Stent–Stone Complex in the Jejunum with Resultant Small Bowel Obstruction: A Case Report
Jiwon Kim, Young Han Kim, Byung-Hee Lee
Journal of the Korean Society of Radiology.2023; 84(2): 512. CrossRef
Use of a pneumatic device for intraluminal enterolith fragmentation in horses
Bruna Machado Amaral Rosa, Peterson Triches Dornbusch, Juan Carlos Duque Moreno, Jackson Schade
Equine Veterinary Education.2023;[Epub] CrossRef
Clinical characteristics and indications for surgery for bezoar-induced small bowel obstruction
Shuai Wang, Xiaohui Yang, Yixiong Zheng, Yulian Wu
Journal of International Medical Research.2021;[Epub] CrossRef
Diagnosis and treatment of the afferent loop syndrome
Panotpol Termsinsuk, Tanyaporn Chantarojanasiri, Nonthalee Pausawasdi
Clinical Journal of Gastroenterology.2020; 13(5): 660. CrossRef
Cola Dissolution Therapy via Ileus Tube Was Effective for Ileus Secondary to Small Bowel Obstruction Induced by an Enterolith
Yuga Komaki, Shuji Kanmura, Akihito Tanaka, Mari Nakashima, Fukiko Komaki, Hiromichi Iwaya, Shiho Arima, Fumisato Sasaki, Yuichiro Nasu, Shiroh Tanoue, Shinichi Hashimoto, Akio Ido
Internal Medicine.2019; 58(17): 2473. CrossRef
Intestinal stones: A rare cause of bowel obstruction
Emilio de León Castorena, Miriam Daniela de León Castorena
SAGE Open Medical Case Reports.2019;[Epub] CrossRef
Afferent loop obstruction with obstructive jaundice and ileus due to an enterolith after distal gastrectomy: A case report
Koki Sato, Masataka Banshodani, Masahiro Nishihara, Junko Nambu, Yasuo Kawaguchi, Fumio Shimamoto, Keizo Sugino, Hideki Ohdan
International Journal of Surgery Case Reports.2018; 50: 9. CrossRef
Afferent Loop Syndrome after Roux-en-Y Total Gastrectomy Caused by Volvulus of the Roux-Limb
Hideki Katagiri, Kana Tahara, Kentaro Yoshikawa, Alan Kawarai Lefor, Tadao Kubota, Ken Mizokami
Case Reports in Surgery.2016; 2016: 1. CrossRef

6,983 View
70 Download
10 Web of Science
8 Crossref

A Case of Gastric Bezoar Formed by Ingestion of Gypsum, and it was Treated Endoscopically Using Electrohydraulic Lithotripsy: Jong Kwan Park, M.D., Min Su Kim, M.D., Young Gyun Kim, M.D., Won Na Suh, M.D., Tae Il Kim, M.D. and Hyojin Park, M.D.; Korean J Gastrointest Endosc 2005;31(5):328-333. Published online November 30, 2005

Abstract PDF: Gastric bezoars are collection of indigestible material in the stomach, and these can be classified into five broad categories: phytobezoar, trichobezoar, pharmacobezoar, lactobezoar and miscellaneous materials such as sand, stone and concrete (gypsum). The treatment of gastric bezoars has recently changed from surgical management to such nonsurgical interventions as enzymatic dissolution, nasogastric suctioning and endoscopic removal by polypectomy snare and basket. Up to the present, electrohydraulic lithotripsy has been a well established method for the treatment of urinary and hepatobiliary stones. We report here on a patient who had a huge gastric bezoar that was formed by the ingestion of gypsum, and this was treated with endoscopic electrohydraulic lithotripsy. (Korean J Gastrointest Endosc 2005;31:328⁣333)

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