Clinical Evaluation of the Effectiveness of Digital Peroral Cholangioscopy-Guided Lithotripsy for Difficult Bile Duct Stones.

BACKGROUND AND AIMS: Peroral cholangioscopy-guided lithotripsy (POCS-L) has emerged as a treatment option for difficult bile duct stones (DBDSs), but detailed evidence remains limited. This study evaluated its effectiveness, safety, and risk factors for adverse events (AEs).

METHODS

We retrospectively analyzed 132 consecutive patients who underwent POCS-L for DBDSs between December 2014 and July 2023 at Tokyo Medical University Hospital. Electrohydraulic lithotripsy or holmium: yttrium-aluminum-garnet laser lithotripsy was performed under cholangioscopic guidance. The primary outcomes were technical and clinical success, and secondary outcomes included procedure-associated AEs and risk factors for cholangitis.

RESULTS

The technical and clinical success rates were 98.5% and 94.7%, respectively, with a median procedure time of 56 min. Clinical success was higher for common bile duct stones than intrahepatic bile duct stones (98.0% vs. 83.9%). Procedure-associated AEs occurred in 29.5% of patients, most commonly transient fever (16.7%) and cholangitis (11.4%). Multivariable analysis identified a stone diameter > 20 mm (odds ratio [OR]: 4.79; p = 0.016) and absence of postprocedural biliary drainage (OR: 3.73; p = 0.048) as independent predictors of cholangitis.

CONCLUSIONS

POCS-L is an effective and safe treatment for DBDSs. Postprocedural biliary drainage may reduce the risk of cholangitis, particularly in patients with large stones.