SWL literature
SWL Literature

Grande G. et al., 2021: Dilation assisted stone extraction for complex biliary lithiasis: Technical aspects and practical principles

Grande G, Cocca S, Bertani H, Caruso A, Pigo' F, Mangiafico S, Russo S, Lupo M, Masciangelo G, Cantu' P, Manta R, Conigliaro R.
Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria di Modena, Modena 41126, Italy.
Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria di Modena, Modena 41126, Italy.
Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milano 20122, Italy.
Gastroenterology and Digestive Endoscopy Unit, General Hospital of Perugia, Perugia 06129, Italy.

Abstract

Common bile duct stones are frequently diagnosed worldwide and are one of the main indications for endoscopic retrograde cholangio-pancreatography. Endoscopic sphincterotomy (EST) has been used for the removal of bile duct stones for the past 40 years, providing a wide opening to allow extraction. Up to 15% of patients present with complicated choledocholithiasis. In this context, additional therapeutic approaches have been proposed such as endoscopic mechanical lithotripsy, intraductal or extracorporeal lithotripsy, or endoscopic papillary large balloon dilation (EPLBD). EPLBD combined with EST was introduced in 2003 to facilitate the passage of large or multiple bile duct stones using a balloon greater than 12 mm in diameter. EPLBD without EST was introduced as a simplified technique in 2009. Dilation-assisted stone extraction (DASE) is the combination of two techniques: EPLBD and sub-maximal EST. Several studies have reported this technique as safe and effective in patients with large bile duct stones, without any increased risk of adverse events such as pancreatitis, bleeding, or perforation. Nevertheless, it is difficult to analyze the outcomes of DASE because there are no standard techniques and definitions between studies. The purpose of this paper is to provide technical guidance and specific information about the main issues regarding DASE, based on current literature and daily clinical experience in biliary referral centers.
World J Gastrointest Endosc. 2021 Feb 16;13(2):33-44. doi: 10.4253/wjge.v13.i2.33.PMID: 33623638 Review. FREE ARTICLE

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Comments 1

Hans-Göran Tiselius on Friday, May 28 2021 08:30

This article describes the importance of a wide sphincter to facilitate passage of common bile duct stones and stone fragments. Either endoscopic sphincterotomy or endoscopic large balloon dilatation are necessary prerequisites when stones are disintegrated. The text in this article has its focus on technical aspects of sphincter dilatation and SWL is mentioned only en passant. It is of note, however, that when bile duct stones are disintegrated with SWL it is necessary to have a wide opening for fragment passage.

Moreover, whereas pancreatic stones usually are radio dense, this is not the case for biliary stones and SWL accordingly requires a biliary catheter for contrast infusion in order to localize the stone(s). This means that although a non-invasive disintegration is the goal, there is nevertheless necessary with an endoscopic procedure.

Hans-Göran Tiselius

This article describes the importance of a wide sphincter to facilitate passage of common bile duct stones and stone fragments. Either endoscopic sphincterotomy or endoscopic large balloon dilatation are necessary prerequisites when stones are disintegrated. The text in this article has its focus on technical aspects of sphincter dilatation and SWL is mentioned only en passant. It is of note, however, that when bile duct stones are disintegrated with SWL it is necessary to have a wide opening for fragment passage. Moreover, whereas pancreatic stones usually are radio dense, this is not the case for biliary stones and SWL accordingly requires a biliary catheter for contrast infusion in order to localize the stone(s). This means that although a non-invasive disintegration is the goal, there is nevertheless necessary with an endoscopic procedure. Hans-Göran Tiselius
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Sunday, December 05 2021

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