A newly hybrid anchoring balloon for direct peroral cholangioscopy using an ultraslim upper endoscope

Abstract

Objectives

Large impacted or residual invisible common bile duct (CBD) stones after mechanical lithotripsy are challenging. We aimed to evaluate the feasibility and success rate of a new hybrid anchoring balloon-guided direct peroral cholangioscopy (POC) for these conditions, using an ultraslim endoscope.

Methods

Sixty-five patients with large or residual invisible CBD stones for direct POC from July 2012 to July 2016 were identified, including 6 cases in whom an additional interventional procedure was required. There were altogether 55 cases undergoing a procedure with our new device, with a 0.021-inch guidewire tied to a balloon catheter at its distal end in this single-center retrospective study. Technical success, the procedure time, diagnostic and therapeutic efficacy of direct POC, and procedure-related complications were studied.

Results

The hybrid anchoring balloon-guided direct POC was successful in 51/55 (92.7%) procedures, including 18 cases in whom the conventional wire-guided method was failed in 25 minutes. The mean time for technical success by our method was 12.4 ± 3.4 minutes. In total, of the 43 cases with previous removal of CBD stones, 7 (16.3%) were found to have residual stones ≥4 mm, excluding 3 cases in whom the direct POC was failed. In other 25 cases for difficult stones, 24 lithotripsies were performed, resulting in 23 complete fragmentation. No significant procedure-related complications were observed.

Conclusions

The new hybrid anchoring balloon device performs well in facilitating direct POC using an ultraslim endoscope for evaluation and extraction of residual or large impacted CBD stones.

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