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Direct cholangioscopy-guided stone extraction
Extracción de piedras guiada por colangioscopia directa
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(B) An estimated 10-mm residual biliary stone in the middle of a diffusely dilated common bile duct, (C) extracted with a small-sheath (5-Fr; working channel 2.0<span class="elsevierStyleHsp" style=""></span>mm) Dormia basket. (D) Confirmation of freedom from stones with high-quality assessment of the biliary system up to the hilum and (not shown), in part, intrahepatic ducts.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An 83-year-old female patient was referred for signs of ongoing cholangitis. Medical history was significant for remote cholecystectomy and multiple preceeding endoscopic retrograde cholangiography (ERC) sessions including endoscopic papillotomy performed elsewhere. After institution of broad-spectrum antibiotics, the patient underwent repeat ERC revealing a diffusely dilated biliary system with the common bile duct (CBD) measuring up to 30<span class="elsevierStyleHsp" style=""></span>mm with multiple stones up to 25<span class="elsevierStyleHsp" style=""></span>mm. Endoscopic papillary large balloon dilation up to 16<span class="elsevierStyleHsp" style=""></span>mm was performed and multiple stones could be extracted with or without mechanical lithotripsy and a plastic stent was inserted due to prolonged procedure time.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient presented again four weeks later as scheduled for ERC with optional direct cholangioscopy (DC). While during conventional ERC again ample stone material could be extracted, fluoroscopy remained unequivocal due to marked biliary dilation. Therefore, the patient underwent freehand-intubated DC using an ultra-slim upper endoscope (working channel 2.0<span class="elsevierStyleHsp" style=""></span>mm) in a retroflexed “<span class="elsevierStyleItalic">hooking</span>” technique<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). A large remaining stone up to 10<span class="elsevierStyleHsp" style=""></span>mm could be appreciated (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B), subsequently grasped and extracted with a 5-Fr-sheath <span class="elsevierStyleItalic">Dormia</span> basket (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). After re-insertion of the repurposed cholangioscope the biliary system could be fully visualized up to the hilum and, in part, beyond excluding further stone material<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">Nothing to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1204 "Ancho" => 1600 "Tamanyo" => 362659 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Retroflexed view in the descending duodenum with multiple stones during freehand intubation of the papilla for direct cholangioscopy access using an ultra-slim upper endoscope (“hooking” technique). (B) An estimated 10-mm residual biliary stone in the middle of a diffusely dilated common bile duct, (C) extracted with a small-sheath (5-Fr; working channel 2.0<span class="elsevierStyleHsp" style=""></span>mm) Dormia basket. (D) Confirmation of freedom from stones with high-quality assessment of the biliary system up to the hilum and (not shown), in part, intrahepatic ducts.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic management of difficult bile duct stones" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Aburajab" 1 => "K. Dua" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11894-018-0613-1" "Revista" => array:5 [ "tituloSerie" => "Curr Gastroenterol Rep" "fecha" => "2018" "volumen" => "20" "paginaInicial" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29572696" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ERC vs. direct cholangioscopy: Dawn of a new reference standard" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "V. Zimmer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.dld.2017.09.126" "Revista" => array:6 [ "tituloSerie" => "Dig Liver Dis" "fecha" => "2018" "volumen" => "50" "paginaInicial" => "199" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29089269" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0167527317311282" "estado" => "S300" "issn" => "01675273" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Positioning cholangioscopy in bile duct stone management: mind the technology gap" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "V. Zimmer" 1 => "F. Lammert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/flgastro-2018-100963" "Revista" => array:7 [ "tituloSerie" => "Frontline Gastroenterol" "fecha" => "2018" "volumen" => "9" "paginaInicial" => "315" "paginaFinal" => "316" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30245795" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S000291491501348X" "estado" => "S300" "issn" => "00029149" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24443824/0000004300000010/v3_202102250818/S2444382420301930/v3_202102250818/en/main.assets" "Apartado" => array:4 [ "identificador" => "75461" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images of the month" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24443824/0000004300000010/v3_202102250818/S2444382420301930/v3_202102250818/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382420301930?idApp=UINPBA00004N" ]
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