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Factors Influencing Performance of Cholangioscopy-Guided Lithotripsy Including Available Different Technologies: A Prospective Multicenter Study with 94 Patients

2021Journal article Open access
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dc.contributor.authorAlexandrino, G
dc.contributor.authorLopes, L
dc.contributor.authorFernandes, J
dc.contributor.authorMoreira, M
dc.contributor.authorAraújo, T
dc.contributor.authorCampos, S
dc.contributor.authorLoureiro, R
dc.contributor.authorFigueiredo, L
dc.contributor.authorLourenço, LC
dc.contributor.authorHorta, D
dc.contributor.authorBana e Costa, T
dc.contributor.authorCosta, P
dc.contributor.authorCanena, J
dc.date.accessioned2023-02-05T17:21:32Z
dc.date.available2023-02-05T17:21:32Z
dc.date.issued2021
dc.description.abstractBackground: Peroral cholangioscopy (POC)-guided lithotripsy is an effective treatment for difficult biliary stones. A clear definition of factors associated with the efficacy of POC-guided lithotripsy in one session and the performance of electrohydraulic lithotripsy (EHL) and laser lithotripsy (LL) have not clearly emerged. Methods: This was a non-randomized prospective multicenter study of all consecutive patients who underwent POC lithotripsy (using EHL and/or LL) for difficult biliary stones. The primary endpoint of the study was the number of sessions needed to achieve complete ductal clearance and the factors associated with this outcome. Secondary endpoints included the evaluated efficacies of LL and EHL. Results: Ninety-four patients underwent 113 procedures of EHL or LL. Complete ductal clearance was obtained in 93/94 patients (98.94%). In total, 80/94 patients (85.11%) achieved stone clearance in a single session. In the multivariate analysis, stone size was independently associated with the need for multiple sessions to achieve complete ductal clearance (odds ratio = 1.146, 95% confidence interval: 1.055-1.244; p = 0.001). Using ROC curves and the Youden index, 22 mm was found to be the optimal cutoff for stone size (95% confidence interval: 15.71-28.28; p < 0.001). The majority of the patients (62.8%) underwent LL in the first session. Six patients failed the first session with EHL after using two probes and therefore were crossed over to LL, obtaining ductal clearance in a single additional session with a single LL fiber. EHL was significantly associated with a larger number of probes (2.0 vs. 1.02) to achieve ductal clearance (p < 0.01). The mean procedural time was significantly longer for EHL than for LL [72.1 (SD 16.3 min) versus 51.1 (SD 10.5 min)] (p < 0.01). Conclusions: POC is highly effective for difficult biliary stones. Most patients achieved complete ductal clearance in one session, which was significantly more likely for stones < 22 mm. EHL was significantly associated with the need for more probes and a longer procedural time to achieve ductal clearance.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationDig Dis Sci . 2022 Aug;67(8):4195-4203.pt_PT
dc.identifier.doi10.1007/s10620-021-07305-7pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.26/43626
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.subjectProcedimentos Cirúrgicos do Sistema Biliarpt_PT
dc.subjectCálculos Biliarespt_PT
dc.subjectLitotripsiapt_PT
dc.subjectBiliary Tract Surgical Procedurespt_PT
dc.subjectGallstonespt_PT
dc.subjectLithotripsypt_PT
dc.titleFactors Influencing Performance of Cholangioscopy-Guided Lithotripsy Including Available Different Technologies: A Prospective Multicenter Study with 94 Patientspt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage4203pt_PT
oaire.citation.issue8pt_PT
oaire.citation.startPage4195pt_PT
oaire.citation.titleDigestive Diseases and Sciencespt_PT
oaire.citation.volume67pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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