Treatment outcomes, including risk factors of stone recurrence, for hepatolithiasis using balloon-assisted endoscopy in
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Treatment outcomes, including risk factors of stone recurrence, for hepatolithiasis using balloon‑assisted endoscopy in patients with hepaticojejunostomy (with video) Yuki Ishihara1 · Kazuyuki Matsumoto1 · Hironari Kato1 · Koichiro Tsutsumi1 · Takeshi Tomoda1 · Akihiro Matsumi1 · Kazuya Miyamoto1 · Tatsuhiro Yamazaki1 · Yosuke Saragai1 · Yuki Fujii1 · Daisuke Uchida1 · Shigeru Horiguchi1 · Hiroyuki Okada1 Received: 17 June 2020 / Accepted: 27 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background and study aims Endoscopic treatment outcomes for hepatolithiasis in patients with altered anatomy are not well known. The aim of this study was to evaluate the treatment outcomes of hepatolithiasis in patients with hepaticojejunostomy (HJ) using short-type double-balloon endoscopy (sDBE) and to assess the risk factors for stone recurrence. Patients and methods This was a retrospective cohort study that consisted of 73 patients with hepatolithiasis who underwent bowel reconstruction with HJ at an academic center. Stone removal was performed using sDBE. After balloon-occluded cholangiography using sDBE, peroral direct cholangioscopy (PDCS) using ultraslim endoscopy was performed to check for residual stones, depending on the bowel reconstruction method. Recurrence was defined as the development of cholangitis from stones. Results The success rate of reaching the HJ site was 92% (67/73), and the complete stone removal rate was 93% (62/67) with multiple sessions (mean number 1.5 ± 0.9). The occurrence rate of procedure-related adverse events was 6.8%. Among 58 patients evaluated for stone recurrence, 13 (22%) developed recurrence during a median follow-up period of 2.7 years (interquartile range: 1.5–4.8). Multivariate analyses determined that a stone diameter ≥ 8 mm [odds ratio (OR), 5.57; 95% confidence interval (CI), 1.39–37.2; p = 0.013] and performing PDCS (OR, 0.16; 95% CI, 0.0084–0.90; p = 0.036) were significant factors for stone recurrence. Conclusions Endoscopic treatment using sDBE for hepatolithiasis was effective and safe. PDCS might reduce the rate of stone recurrence by detecting stones that are too small to confirm on fluoroscopic images. Keywords Peroral direct cholangioscopy · Hepatolithiasis · Altered gastrointestinal anatomy · Double-balloon endoscopy Hepatolithiasis is a postoperative complication of hepaticojejunostomy (HJ), which is performed for various pancreatobiliary diseases. Hepatolithiasis can cause repeated episodes of cholangitis, liver abscess, liver cirrhosis, or liver atrophy. Complete stone removal and bile stasis elimination are therefore necessary and have commonly been achieved with a percutaneous approach [1]. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-08139-6) contains supplementary material, which is available to authorized users. * Kazuyuki Matsumoto [email protected] Extended author informatio
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