Abstract：
BACKGROUND: Nonradiation, digital cholangioscope (DCS)-assisted endoscopic intervention for cholelithiasis has not been widely performed. For this study, we aimed to report the feasibility, efficacy, and safety of an established DCS-guided lithotomy procedure.
METHODS: Data relating to biliary exploration, stone clearance, adverse events, and follow-up were obtained from 289 patients. The choledocholithiasis-related outcomes via the DCS-guided procedure were subsequently compared to those via conventional endoscopic retrograde cholangiopancreatography (ERCP).
RESULTS: Biliary access was achieved in 285 patients. The technical success rate for the exploration of the common bile duct, the cystic stump, the hilar ducts, and secondary radicals was 100%. Moreover, the success rates were 98.4%, 61.7%, and 20.7%, for the exploration of the cystic duct, complete cystic duct, and gallbladder, respectively. Suspicious or confirmed suppurative cholecystitis, cholesterol polyps, and hyperplastic polyps were detected in 42, 23, and 5 patients, respectively. Stone clearance was achieved in one session in 285 (100%), 11 (100%), 13 (100%), 7 (100%), 6 (100%), and 3 (14.3%) patients with choledocholithiasis and hepatolithiasis, cystic duct stump stones, nondiffuse located intrahepatic lithiasis, a single cystic duct stone, a single gallbladder stone, and diffuse located intrahepatic lithiasis, respectively. Complete stone clearance for diffuse intrahepatic lithiasis was achieved in 19 (90.5%) patients, and fractioned re-lithotomy was performed in 16 (76.2%) patients. One patient developed mild acute cholangitis, and 12 developed mild pancreatitis. Stones recurred in one patient. Compared with conventional ERCP, DCS-guided lithotomy has the advantages of clearing difficult-to-treat choledocholithiasis and revealing concomitant biliary lesions, and this technique has fewer complications and a decreased risk of stone recurrence.
CONCLUSIONS: The technical profile, efficacy, and safety of nonradiation-guided and DCS-guided lithotomy are shown in this study. We provide a feasible modality for the endoscopic removal of cholelithiasis.
METHODS: Data relating to biliary exploration, stone clearance, adverse events, and follow-up were obtained from 289 patients. The choledocholithiasis-related outcomes via the DCS-guided procedure were subsequently compared to those via conventional endoscopic retrograde cholangiopancreatography (ERCP).
RESULTS: Biliary access was achieved in 285 patients. The technical success rate for the exploration of the common bile duct, the cystic stump, the hilar ducts, and secondary radicals was 100%. Moreover, the success rates were 98.4%, 61.7%, and 20.7%, for the exploration of the cystic duct, complete cystic duct, and gallbladder, respectively. Suspicious or confirmed suppurative cholecystitis, cholesterol polyps, and hyperplastic polyps were detected in 42, 23, and 5 patients, respectively. Stone clearance was achieved in one session in 285 (100%), 11 (100%), 13 (100%), 7 (100%), 6 (100%), and 3 (14.3%) patients with choledocholithiasis and hepatolithiasis, cystic duct stump stones, nondiffuse located intrahepatic lithiasis, a single cystic duct stone, a single gallbladder stone, and diffuse located intrahepatic lithiasis, respectively. Complete stone clearance for diffuse intrahepatic lithiasis was achieved in 19 (90.5%) patients, and fractioned re-lithotomy was performed in 16 (76.2%) patients. One patient developed mild acute cholangitis, and 12 developed mild pancreatitis. Stones recurred in one patient. Compared with conventional ERCP, DCS-guided lithotomy has the advantages of clearing difficult-to-treat choledocholithiasis and revealing concomitant biliary lesions, and this technique has fewer complications and a decreased risk of stone recurrence.
CONCLUSIONS: The technical profile, efficacy, and safety of nonradiation-guided and DCS-guided lithotomy are shown in this study. We provide a feasible modality for the endoscopic removal of cholelithiasis.
摘要：
背景：无辐射，数字胆管镜(DCS)辅助的胆石症内镜介入治疗尚未得到广泛应用.对于这项研究，我们的目的是报告可行性，功效,以及已建立的DCS引导的切开取石术的安全性。
方法：与胆道探查有关的数据，石材间隙,不良事件,并对289例患者进行了随访。随后将通过DCS指导程序与胆总管结石相关的结局与通过常规内镜逆行胰胆管造影术（ERCP）进行比较。
结果：285例患者获得了胆道通路。胆总管探查术的技术成功率,囊性残端,肺门导管,次自由基为100%。此外，成功率为98.4%，61.7%,和20.7%，为了探索胆囊管，完整的胆囊管，和胆囊，分别。可疑或确认的化脓性胆囊炎，胆固醇息肉,在42、23和5例患者中检测到增生性息肉，分别。在285年的一次会议中实现了石块清除（100％），11（100%），13（100%），7（100%），6（100%），胆总管结石和肝胆管结石3例(14.3%),胆囊管残端结石，非弥漫性肝内结石，一个胆囊管结石,一个胆囊结石,和弥漫性肝内结石，分别。19例（90.5%）患者获得弥漫性肝内结石完全清除结石，16例(76.2%)患者进行了再次切开取石术。一名患者出现轻度急性胆管炎,和12发展为轻度胰腺炎。一名患者结石复发。与常规ERCP相比,DCS引导下的取石术具有清除难以治疗的胆总管结石和显示伴随的胆道病变的优点，这种技术的并发症少，结石复发的风险降低。
结论：技术概况，功效,本研究显示了非放射引导和DCS引导的碎石术的安全性。我们为内镜清除胆石症提供了可行的方法。
方法：与胆道探查有关的数据，石材间隙,不良事件,并对289例患者进行了随访。随后将通过DCS指导程序与胆总管结石相关的结局与通过常规内镜逆行胰胆管造影术（ERCP）进行比较。
结果：285例患者获得了胆道通路。胆总管探查术的技术成功率,囊性残端,肺门导管,次自由基为100%。此外，成功率为98.4%，61.7%,和20.7%，为了探索胆囊管，完整的胆囊管，和胆囊，分别。可疑或确认的化脓性胆囊炎，胆固醇息肉,在42、23和5例患者中检测到增生性息肉，分别。在285年的一次会议中实现了石块清除（100％），11（100%），13（100%），7（100%），6（100%），胆总管结石和肝胆管结石3例(14.3%),胆囊管残端结石，非弥漫性肝内结石，一个胆囊管结石,一个胆囊结石,和弥漫性肝内结石，分别。19例（90.5%）患者获得弥漫性肝内结石完全清除结石，16例(76.2%)患者进行了再次切开取石术。一名患者出现轻度急性胆管炎,和12发展为轻度胰腺炎。一名患者结石复发。与常规ERCP相比,DCS引导下的取石术具有清除难以治疗的胆总管结石和显示伴随的胆道病变的优点，这种技术的并发症少，结石复发的风险降低。
结论：技术概况，功效,本研究显示了非放射引导和DCS引导的碎石术的安全性。我们为内镜清除胆石症提供了可行的方法。
