Abstract
Background
Peroral cholangioscopy-directed lithotripsy (PC-directed lithotripsy) has been successfully used for the treatment of difficult bile duct stones, including Mirizzi syndrome (MS). However, long-term outcome and risk factors for stone recurrence after PC-directed lithotripsy have not yet been elucidated. The aim of this study was to assess the outcomes of long-term follow-up after PC-directed lithotripsy and to clarify risk factors predicting stone recurrence.
Methods
One hundred twenty-two consecutive patients with difficult bile duct stones, including MS type II (McSherry classification system), were included in the study.
Results
Successful stone removal was achieved in 117 (95.9%) of the 122 patients treated with PC-directed lithotripsy. Of these 117 patients, reliable follow-up information for a median period of 5.5 years (range = 0.19–16.6) was obtained for 111 patients (94.9%) in whom stone type was classified into one of the following three categories: (1) MS type II (47 patients); (2) impacted stones (45 patients); and (3) large stones (≥20 mm in short diameter, 19 patients). Bile duct stone recurrence was observed in 18 patients (16.1%), of whom 4 had MS type II, 9 had impacted stones, and 5 had large stones. Statistical analysis showed that dilated bile duct diameter greater than or equal to 20 mm was the only risk factor for stone recurrence.
Conclusions
PC-directed lithotripsy used for the treatment of difficult bile duct stones, including MS type II and impacted stones, and is found to be safe at long-term follow-up. Dilated bile duct diameter is the only risk factor for stone recurrence. Careful follow-up is indispensable, particularly for patients with dilated bile ducts.
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Abbreviations
- PC:
-
Peroral cholangioscopy
- MS:
-
Mirizzi syndrome
- ML:
-
Mechanical lithotripsy
- ERCP:
-
Endoscopic retrograde cholangiopancreatography
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Disclosures
Drs. Tsuyuguchi, Sakai, Sugiyma, Ishihara, and Yokosuka have no conflicts of interest or financial ties to disclose.
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Tsuyuguchi, T., Sakai, Y., Sugiyama, H. et al. Long-term follow-up after peroral cholangioscopy-directed lithotripsy in patients with difficult bile duct stones, including Mirizzi syndrome: an analysis of risk factors predicting stone recurrence. Surg Endosc 25, 2179–2185 (2011). https://doi.org/10.1007/s00464-010-1520-1
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DOI: https://doi.org/10.1007/s00464-010-1520-1