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Torsten Beyna - One of the best experts on this subject based on the ideXlab platform.
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Clinical Management of Bile Duct Diseases: Role of Endoscopic Ultrasound in a Personalized Approach.
Journal of personalized medicine, 2020Co-Authors: Torsten Beyna, Christian GergesAbstract:Biliary Diseases are common, but clinical symptoms are often unspecific and direct access and visualization of the biliopancreatic system for diagnostic purpose is difficult. In the last decades endoscopic ultrasound (EUS) has become a primary method in the gastrointestinal tract. It significantly changed the role of endoscopy in diagnostic imaging in the gastrointestinal tract and adjacent organs. EUS has become an effective diagnostic tool in Biliary Stone Disease as well as in the diagnosis of indeterminate Biliary strictures. Furthermore, an EUS-directed transmural approach emerged as a safe and effective alternative to ERCP in patients requiring Biliary drainage, in particular as a backup method if standard ERCP-approach fails. Development of new techniques, specific accessories and stents during the last decade led to an enormous step forward in terms of efficacy and safety of an EUS-directed approach. In the current article technical and clinical aspects of EUS-guided diagnostic and therapeutic approaches in different clinical indications will be discussed together with a review of the available data.
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Digital single-operator video cholangioscopy in treating refractory Biliary Stones: a multicenter observational study
Surgical Endoscopy, 2020Co-Authors: Arne Bokemeyer, Christian Gerges, Diana Lang, Dominik Bettenworth, Iyad Kabar, Hartmut Schmidt, Horst Neuhaus, Hansjoerg Ullerich, Frank Lenze, Torsten BeynaAbstract:Background Standard endoscopic treatment might fail to treat Biliary Stone Disease. Here, we investigated the efficacy and safety of recently introduced digital single-operator video cholangioscopy (SOVC) for the treatment of difficult Biliary Stones. Methods Digital SOVC procedures, performed in two tertiary referral centers between 2015 and 2018, were retrospectively analyzed. Only patients with a previous failure of endoscopic standard treatment and a SOVC-based Biliary Stone treatment using electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL) were included. The primary endpoint was to evaluate the Stone removal rate per procedure and per patient. Results In total, 75 examinations with a digital SOVC-assisted Biliary Stone treatment, performed in 60 patients, were identified. Biliary Stones were mainly located extrahepatic (64%) and less frequently intrahepatic (36%). The median Stone size was 20 mm (interquartile range [IQR]: 10–25 mm) and the median Stone number was 1 (IQR: 1–2). Digital SOVC-based treatment of Biliary Stone Disease was successful in 95% of patients and 15% needed at least two treatment sessions. Evaluated per procedure, a complete Stone removal was accomplished in 67% of all examinations (including initial and repeated procedures), while an incomplete Stone removal was observed in 33% of cases. The per procedure analyzes revealed that the success rates for a complete Stone removal were similar between LL and EHL (66% vs. 68%; p = 0.87). Complications, such as postinterventional cholangitis and pancreatitis occurred in 16% of examinations; however, except from one case, all were mild or moderate and no procedure-associated mortality occurred. Conclusions Digital SOVC-assisted Biliary Stone treatment is highly effective even in cases with difficult Biliary Stones and might be considered the new standard of care for these patients. Furthermore, mild up to moderate complications were intermittently observed which might document the complexity of our included cases.
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Digital single-operator video cholangioscopy in treating refractory Biliary Stones: a multicenter observational study.
Surgical endoscopy, 2019Co-Authors: Arne Bokemeyer, Christian Gerges, Diana Lang, Dominik Bettenworth, Iyad Kabar, Hartmut Schmidt, Horst Neuhaus, Hansjoerg Ullerich, Frank Lenze, Torsten BeynaAbstract:Standard endoscopic treatment might fail to treat Biliary Stone Disease. Here, we investigated the efficacy and safety of recently introduced digital single-operator video cholangioscopy (SOVC) for the treatment of difficult Biliary Stones. Digital SOVC procedures, performed in two tertiary referral centers between 2015 and 2018, were retrospectively analyzed. Only patients with a previous failure of endoscopic standard treatment and a SOVC-based Biliary Stone treatment using electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL) were included. The primary endpoint was to evaluate the Stone removal rate per procedure and per patient. In total, 75 examinations with a digital SOVC-assisted Biliary Stone treatment, performed in 60 patients, were identified. Biliary Stones were mainly located extrahepatic (64%) and less frequently intrahepatic (36%). The median Stone size was 20 mm (interquartile range [IQR]: 10-25 mm) and the median Stone number was 1 (IQR: 1-2). Digital SOVC-based treatment of Biliary Stone Disease was successful in 95% of patients and 15% needed at least two treatment sessions. Evaluated per procedure, a complete Stone removal was accomplished in 67% of all examinations (including initial and repeated procedures), while an incomplete Stone removal was observed in 33% of cases. The per procedure analyzes revealed that the success rates for a complete Stone removal were similar between LL and EHL (66% vs. 68%; p = 0.87). Complications, such as postinterventional cholangitis and pancreatitis occurred in 16% of examinations; however, except from one case, all were mild or moderate and no procedure-associated mortality occurred. Digital SOVC-assisted Biliary Stone treatment is highly effective even in cases with difficult Biliary Stones and might be considered the new standard of care for these patients. Furthermore, mild up to moderate complications were intermittently observed which might document the complexity of our included cases.
Arne Bokemeyer - One of the best experts on this subject based on the ideXlab platform.
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Digital single-operator video cholangioscopy in treating refractory Biliary Stones: a multicenter observational study
Surgical Endoscopy, 2020Co-Authors: Arne Bokemeyer, Christian Gerges, Diana Lang, Dominik Bettenworth, Iyad Kabar, Hartmut Schmidt, Horst Neuhaus, Hansjoerg Ullerich, Frank Lenze, Torsten BeynaAbstract:Background Standard endoscopic treatment might fail to treat Biliary Stone Disease. Here, we investigated the efficacy and safety of recently introduced digital single-operator video cholangioscopy (SOVC) for the treatment of difficult Biliary Stones. Methods Digital SOVC procedures, performed in two tertiary referral centers between 2015 and 2018, were retrospectively analyzed. Only patients with a previous failure of endoscopic standard treatment and a SOVC-based Biliary Stone treatment using electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL) were included. The primary endpoint was to evaluate the Stone removal rate per procedure and per patient. Results In total, 75 examinations with a digital SOVC-assisted Biliary Stone treatment, performed in 60 patients, were identified. Biliary Stones were mainly located extrahepatic (64%) and less frequently intrahepatic (36%). The median Stone size was 20 mm (interquartile range [IQR]: 10–25 mm) and the median Stone number was 1 (IQR: 1–2). Digital SOVC-based treatment of Biliary Stone Disease was successful in 95% of patients and 15% needed at least two treatment sessions. Evaluated per procedure, a complete Stone removal was accomplished in 67% of all examinations (including initial and repeated procedures), while an incomplete Stone removal was observed in 33% of cases. The per procedure analyzes revealed that the success rates for a complete Stone removal were similar between LL and EHL (66% vs. 68%; p = 0.87). Complications, such as postinterventional cholangitis and pancreatitis occurred in 16% of examinations; however, except from one case, all were mild or moderate and no procedure-associated mortality occurred. Conclusions Digital SOVC-assisted Biliary Stone treatment is highly effective even in cases with difficult Biliary Stones and might be considered the new standard of care for these patients. Furthermore, mild up to moderate complications were intermittently observed which might document the complexity of our included cases.
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Digital single-operator video cholangioscopy in treating refractory Biliary Stones: a multicenter observational study.
Surgical endoscopy, 2019Co-Authors: Arne Bokemeyer, Christian Gerges, Diana Lang, Dominik Bettenworth, Iyad Kabar, Hartmut Schmidt, Horst Neuhaus, Hansjoerg Ullerich, Frank Lenze, Torsten BeynaAbstract:Standard endoscopic treatment might fail to treat Biliary Stone Disease. Here, we investigated the efficacy and safety of recently introduced digital single-operator video cholangioscopy (SOVC) for the treatment of difficult Biliary Stones. Digital SOVC procedures, performed in two tertiary referral centers between 2015 and 2018, were retrospectively analyzed. Only patients with a previous failure of endoscopic standard treatment and a SOVC-based Biliary Stone treatment using electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL) were included. The primary endpoint was to evaluate the Stone removal rate per procedure and per patient. In total, 75 examinations with a digital SOVC-assisted Biliary Stone treatment, performed in 60 patients, were identified. Biliary Stones were mainly located extrahepatic (64%) and less frequently intrahepatic (36%). The median Stone size was 20 mm (interquartile range [IQR]: 10-25 mm) and the median Stone number was 1 (IQR: 1-2). Digital SOVC-based treatment of Biliary Stone Disease was successful in 95% of patients and 15% needed at least two treatment sessions. Evaluated per procedure, a complete Stone removal was accomplished in 67% of all examinations (including initial and repeated procedures), while an incomplete Stone removal was observed in 33% of cases. The per procedure analyzes revealed that the success rates for a complete Stone removal were similar between LL and EHL (66% vs. 68%; p = 0.87). Complications, such as postinterventional cholangitis and pancreatitis occurred in 16% of examinations; however, except from one case, all were mild or moderate and no procedure-associated mortality occurred. Digital SOVC-assisted Biliary Stone treatment is highly effective even in cases with difficult Biliary Stones and might be considered the new standard of care for these patients. Furthermore, mild up to moderate complications were intermittently observed which might document the complexity of our included cases.
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Safety, diagnostic accuracy and therapeutic efficacy of digital single-operator cholangioscopy
United European gastroenterology journal, 2018Co-Authors: Frank Lenze, Arne Bokemeyer, Dominik Bettenworth, Dina Gross, Tobias M. Nowacki, Hansjoerg UllerichAbstract:Digital single-operator cholangioscopes (digital SOCs), equipped with an improved image quality, have been recently introduced. The aim of this study is to evaluate the safety and diagnostic and therapeutic efficacy of digital SOCs (Spyglass™ DS). Sixty-seven digital SOC procedures performed between 2015 and 2017 were retrospectively analyzed. The most frequent indications for examination were indeterminate Biliary strictures (61.2%) and Biliary Stone Disease (23.9%). In 25 patients (37.3), visual findings predicted malignancy with a sensitivity of 88.9%, a specificity of 97.6%, a positive predictive value (PPV) of 96.0% and a negative predictive value (NPV) of 92.9%. For histological analysis, forceps biopsies were performed in 29 patients (43.2%). Compared with visual findings, forceps biopsies yield a lower diagnostic efficacy in diagnosing malignancy (sensitivity 62.5%, specificity 90.0%, PPV 90.9%, NPV 60.0%). Therapeutic interventions were performed in 19 patients with a technical success rate of 89.4%. Adverse events were observed in 17 patients (25.4%). Of these, 11 patients (16.4%) suffered from severe adverse events (pancreatitis, cholangitis or major bleeding), which led to a prolonged hospital stay. Digital SOCs have excellent diagnostic and therapeutic efficacies, but are accompanied by high rates of adverse events; therefore, physicians should use digital SOCs in carefully selected cases.
Nicole Brighi - One of the best experts on this subject based on the ideXlab platform.
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Biliary Stone Disease in Patients with Neuroendocrine Tumors Treated with Somatostatin Analogs: A Multicenter Study.
The oncologist, 2019Co-Authors: Nicole Brighi, Francesco Panzuto, Roberta Modica, Fabio Gelsomino, Manuela Albertelli, Sara Pusceddu, Sara Massironi, Giuseppe Lamberti, Maria Rinzivillo, Antongiulio FaggianoAbstract:Somatostatin analogs (SSAs) are the mainstay of neuroendocrine tumor (NET) treatment. Biliary Stone Disease is reported as a common side effect of SSAs, with a frequency ranging from 10% to 63%. Studies on SSA-treated patients for acromegaly report an increased incidence of Biliary Stone Disease compared with the general population, whereas data on patients with NETs are few. Guidelines are based on weak evidence, thus resulting in conflicting recommendations. The aim of the study is to evaluate Biliary Stone Disease incidence, complications, and risk factors in a large population of SSA-treated patients with NETs. A retrospective analysis of a prospectively collected database was performed. Patients with a diagnosis of NET in seven dedicated centers from 1995 to 2017 were included at the time of SSA start. A total of 754 SSA-treated patients were evaluated. Patients with history of cholecystectomy or with known Biliary Stone Disease were excluded; 478 patients were included. Among them, 118 patients (24.7%) received prophylactic ursodeoxycholic acid (UDCA). During the study period, 129 patients (27.0%) developed Biliary Stone Disease; of them, 36 (27.9%) developed Biliary complications. On multivariate analysis, primary gastrointestinal (GI)-NET (hazard ratio [HR] 1.76) and related surgery (HR 1.58) were independent risk factors for Biliary Stone Disease. We report a high incidence of Biliary Stone Disease particularly in GI-NET or GI surgery. UDCA prophylaxis does not seem to have a protective role. Our data suggest that all patients with primary GI-NET or undergoing abdominal surgery should be considered for prophylactic cholecystectomy; no conclusion could be drawn on the indication of prophylactic cholecystectomy in patients with primary pancreatic or thoracic NET for whom abdominal surgery is not planned. The results of this study confirm an increased rate of gallStones development and related complications in patients with neuroendocrine tumors (NETs) treated with somatostatin analogs (SSAs). NETs of the gastrointestinal (GI) tract and related surgery are independent risk factors for Biliary Stone Disease development. Therefore, all patients with primary GI-NET or undergoing abdominal surgery should be considered for prophylactic cholecystectomy. Data on other subgroups are not exhaustive, and management also evaluating additional clinical features (life expectancy, surgical and anesthesiological risks) should be considered. Prophylactic treatment with ursodeoxycholic acid does not seem to be a protective factor for SSA-related Biliary Stone Disease. © AlphaMed Press 2019.
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Nonconventional Doses of Somatostatin Analogs in Patients With Progressing Well-Differentiated Neuroendocrine Tumor
The Journal of clinical endocrinology and metabolism, 2019Co-Authors: Giuseppe Lamberti, Nicole Brighi, Manuela Albertelli, Sara Pusceddu, Sara Massironi, Antongiulio Faggiano, Salvatore Tafuto, Toni Ibrahim, Maria Pia Brizzi, Francesco PanzutoAbstract:Purpose To evaluate the antiproliferative activity and safety of nonconventional high doses of somatostatin analogs (HD-SSA) in patients with well-differentiated gastroenteropancreatic (GEP) neuroendocrine tumors (NET) with radiological Disease progression according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria on a previous treatment. Methods A retrospective analysis of prospectively maintained databases from 13 Italian NET-dedicated centers was performed. Main inclusion criteria were: well-differentiated G1 or G2 GEP-NET, progressive Disease on a previous treatment, and subsequent treatment with HD-SSA (either by increased administered dose [dose intensity] or shortened interval between administrations [dose density]). Main endpoints were progression-free survival (PFS) and safety. Results Of 198 patients, 140 matched inclusion criteria and were included in the analysis. Overall, median PFS was 31 months. Use of HD-SSA as second-line treatment was associated with reduced risk for progression or death compared with third- or further-line treatment (HR: 2.12; P = 0.004). There was no difference in PFS between HD-SSA by increased dose density (N = 133; 95%) or intensity (N = 7; 5%). Partial response according to RECIST criteria was observed in 12 patients (8.6%), and stable Disease was achieved in 106 (75.7%) patients. Adverse events occurred in 21 patients (15.0%), 2 of whom had grade 3 Biliary Stone Disease. No patients discontinued HD-SSA treatment due to adverse events. Conclusions HD-SSA is an active and safe treatment option in patients with progressive well-differentiated GEP-NET. The high rate of objective responses observed deserves prospective validation in ad hoc clinical trials.
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Biliary Stone Disease in patients receiving somatostatin analogs for neuroendocrine neoplasms. A retrospective observational study.
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 2018Co-Authors: Nicole Brighi, Giuseppe Lamberti, Ilaria Maggio, Lisa Manuzzi, Claudio Ricci, Riccardo Casadei, Donatella Santini, Cristina Mosconi, Andrea Lisotti, Valentina AmbrosiniAbstract:Abstract Background Somatostatin analogs are the backbone of neuroendocrine neoplasms treatment. Biliary Stone Disease is a potentially severe adverse event of somatostatin analogs: an increased incidence has been reported in somatostatin analogs-treated acromegalic patients, but studies on patients with neuroendocrine neoplasms are lacking. Aims To evaluate Biliary Stone Disease incidence and associated factors in a large series of patients treated with somatostatin analogs for neuroendocrine neoplasms. Methods A prospectively-collected database of patients with a diagnosis of neuroendocrine neoplasms of any grade and site, treated with somatostatin analogs at our Institution between 1995 and 2017, was retrospectively analyzed. Patients’ demographics and Disease characteristics were analyzed to evaluate the incidence and the factors related to Biliary Stone Disease. Results Three-hundred patients were included; 101 (33.7%) patients underwent cholecystectomy before starting somatostatin analogs. Among 164 patients with gallbladder in situ and no history of Stone Disease, 60 (36.6%) developed gallStones after a mean of 36.7 months (range 1–239) from treatment start with a mean yearly incidence of 8.73%. Previous cholecystectomy was associated with a lower rate of development of gallStones (p Conclusion We observed a high incidence of Biliary Stone Disease in patients treated with somatostatin analogs-treated for neuroendocrine neoplams. Previous cholecystectomy was the only factor associated with a lower occurrence of Biliary Stone Disease.
Hansjoerg Ullerich - One of the best experts on this subject based on the ideXlab platform.
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Digital single-operator video cholangioscopy in treating refractory Biliary Stones: a multicenter observational study
Surgical Endoscopy, 2020Co-Authors: Arne Bokemeyer, Christian Gerges, Diana Lang, Dominik Bettenworth, Iyad Kabar, Hartmut Schmidt, Horst Neuhaus, Hansjoerg Ullerich, Frank Lenze, Torsten BeynaAbstract:Background Standard endoscopic treatment might fail to treat Biliary Stone Disease. Here, we investigated the efficacy and safety of recently introduced digital single-operator video cholangioscopy (SOVC) for the treatment of difficult Biliary Stones. Methods Digital SOVC procedures, performed in two tertiary referral centers between 2015 and 2018, were retrospectively analyzed. Only patients with a previous failure of endoscopic standard treatment and a SOVC-based Biliary Stone treatment using electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL) were included. The primary endpoint was to evaluate the Stone removal rate per procedure and per patient. Results In total, 75 examinations with a digital SOVC-assisted Biliary Stone treatment, performed in 60 patients, were identified. Biliary Stones were mainly located extrahepatic (64%) and less frequently intrahepatic (36%). The median Stone size was 20 mm (interquartile range [IQR]: 10–25 mm) and the median Stone number was 1 (IQR: 1–2). Digital SOVC-based treatment of Biliary Stone Disease was successful in 95% of patients and 15% needed at least two treatment sessions. Evaluated per procedure, a complete Stone removal was accomplished in 67% of all examinations (including initial and repeated procedures), while an incomplete Stone removal was observed in 33% of cases. The per procedure analyzes revealed that the success rates for a complete Stone removal were similar between LL and EHL (66% vs. 68%; p = 0.87). Complications, such as postinterventional cholangitis and pancreatitis occurred in 16% of examinations; however, except from one case, all were mild or moderate and no procedure-associated mortality occurred. Conclusions Digital SOVC-assisted Biliary Stone treatment is highly effective even in cases with difficult Biliary Stones and might be considered the new standard of care for these patients. Furthermore, mild up to moderate complications were intermittently observed which might document the complexity of our included cases.
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Digital single-operator video cholangioscopy in treating refractory Biliary Stones: a multicenter observational study.
Surgical endoscopy, 2019Co-Authors: Arne Bokemeyer, Christian Gerges, Diana Lang, Dominik Bettenworth, Iyad Kabar, Hartmut Schmidt, Horst Neuhaus, Hansjoerg Ullerich, Frank Lenze, Torsten BeynaAbstract:Standard endoscopic treatment might fail to treat Biliary Stone Disease. Here, we investigated the efficacy and safety of recently introduced digital single-operator video cholangioscopy (SOVC) for the treatment of difficult Biliary Stones. Digital SOVC procedures, performed in two tertiary referral centers between 2015 and 2018, were retrospectively analyzed. Only patients with a previous failure of endoscopic standard treatment and a SOVC-based Biliary Stone treatment using electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL) were included. The primary endpoint was to evaluate the Stone removal rate per procedure and per patient. In total, 75 examinations with a digital SOVC-assisted Biliary Stone treatment, performed in 60 patients, were identified. Biliary Stones were mainly located extrahepatic (64%) and less frequently intrahepatic (36%). The median Stone size was 20 mm (interquartile range [IQR]: 10-25 mm) and the median Stone number was 1 (IQR: 1-2). Digital SOVC-based treatment of Biliary Stone Disease was successful in 95% of patients and 15% needed at least two treatment sessions. Evaluated per procedure, a complete Stone removal was accomplished in 67% of all examinations (including initial and repeated procedures), while an incomplete Stone removal was observed in 33% of cases. The per procedure analyzes revealed that the success rates for a complete Stone removal were similar between LL and EHL (66% vs. 68%; p = 0.87). Complications, such as postinterventional cholangitis and pancreatitis occurred in 16% of examinations; however, except from one case, all were mild or moderate and no procedure-associated mortality occurred. Digital SOVC-assisted Biliary Stone treatment is highly effective even in cases with difficult Biliary Stones and might be considered the new standard of care for these patients. Furthermore, mild up to moderate complications were intermittently observed which might document the complexity of our included cases.
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Safety, diagnostic accuracy and therapeutic efficacy of digital single-operator cholangioscopy
United European gastroenterology journal, 2018Co-Authors: Frank Lenze, Arne Bokemeyer, Dominik Bettenworth, Dina Gross, Tobias M. Nowacki, Hansjoerg UllerichAbstract:Digital single-operator cholangioscopes (digital SOCs), equipped with an improved image quality, have been recently introduced. The aim of this study is to evaluate the safety and diagnostic and therapeutic efficacy of digital SOCs (Spyglass™ DS). Sixty-seven digital SOC procedures performed between 2015 and 2017 were retrospectively analyzed. The most frequent indications for examination were indeterminate Biliary strictures (61.2%) and Biliary Stone Disease (23.9%). In 25 patients (37.3), visual findings predicted malignancy with a sensitivity of 88.9%, a specificity of 97.6%, a positive predictive value (PPV) of 96.0% and a negative predictive value (NPV) of 92.9%. For histological analysis, forceps biopsies were performed in 29 patients (43.2%). Compared with visual findings, forceps biopsies yield a lower diagnostic efficacy in diagnosing malignancy (sensitivity 62.5%, specificity 90.0%, PPV 90.9%, NPV 60.0%). Therapeutic interventions were performed in 19 patients with a technical success rate of 89.4%. Adverse events were observed in 17 patients (25.4%). Of these, 11 patients (16.4%) suffered from severe adverse events (pancreatitis, cholangitis or major bleeding), which led to a prolonged hospital stay. Digital SOCs have excellent diagnostic and therapeutic efficacies, but are accompanied by high rates of adverse events; therefore, physicians should use digital SOCs in carefully selected cases.
Frank Lenze - One of the best experts on this subject based on the ideXlab platform.
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Digital single-operator video cholangioscopy in treating refractory Biliary Stones: a multicenter observational study
Surgical Endoscopy, 2020Co-Authors: Arne Bokemeyer, Christian Gerges, Diana Lang, Dominik Bettenworth, Iyad Kabar, Hartmut Schmidt, Horst Neuhaus, Hansjoerg Ullerich, Frank Lenze, Torsten BeynaAbstract:Background Standard endoscopic treatment might fail to treat Biliary Stone Disease. Here, we investigated the efficacy and safety of recently introduced digital single-operator video cholangioscopy (SOVC) for the treatment of difficult Biliary Stones. Methods Digital SOVC procedures, performed in two tertiary referral centers between 2015 and 2018, were retrospectively analyzed. Only patients with a previous failure of endoscopic standard treatment and a SOVC-based Biliary Stone treatment using electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL) were included. The primary endpoint was to evaluate the Stone removal rate per procedure and per patient. Results In total, 75 examinations with a digital SOVC-assisted Biliary Stone treatment, performed in 60 patients, were identified. Biliary Stones were mainly located extrahepatic (64%) and less frequently intrahepatic (36%). The median Stone size was 20 mm (interquartile range [IQR]: 10–25 mm) and the median Stone number was 1 (IQR: 1–2). Digital SOVC-based treatment of Biliary Stone Disease was successful in 95% of patients and 15% needed at least two treatment sessions. Evaluated per procedure, a complete Stone removal was accomplished in 67% of all examinations (including initial and repeated procedures), while an incomplete Stone removal was observed in 33% of cases. The per procedure analyzes revealed that the success rates for a complete Stone removal were similar between LL and EHL (66% vs. 68%; p = 0.87). Complications, such as postinterventional cholangitis and pancreatitis occurred in 16% of examinations; however, except from one case, all were mild or moderate and no procedure-associated mortality occurred. Conclusions Digital SOVC-assisted Biliary Stone treatment is highly effective even in cases with difficult Biliary Stones and might be considered the new standard of care for these patients. Furthermore, mild up to moderate complications were intermittently observed which might document the complexity of our included cases.
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Digital single-operator video cholangioscopy in treating refractory Biliary Stones: a multicenter observational study.
Surgical endoscopy, 2019Co-Authors: Arne Bokemeyer, Christian Gerges, Diana Lang, Dominik Bettenworth, Iyad Kabar, Hartmut Schmidt, Horst Neuhaus, Hansjoerg Ullerich, Frank Lenze, Torsten BeynaAbstract:Standard endoscopic treatment might fail to treat Biliary Stone Disease. Here, we investigated the efficacy and safety of recently introduced digital single-operator video cholangioscopy (SOVC) for the treatment of difficult Biliary Stones. Digital SOVC procedures, performed in two tertiary referral centers between 2015 and 2018, were retrospectively analyzed. Only patients with a previous failure of endoscopic standard treatment and a SOVC-based Biliary Stone treatment using electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL) were included. The primary endpoint was to evaluate the Stone removal rate per procedure and per patient. In total, 75 examinations with a digital SOVC-assisted Biliary Stone treatment, performed in 60 patients, were identified. Biliary Stones were mainly located extrahepatic (64%) and less frequently intrahepatic (36%). The median Stone size was 20 mm (interquartile range [IQR]: 10-25 mm) and the median Stone number was 1 (IQR: 1-2). Digital SOVC-based treatment of Biliary Stone Disease was successful in 95% of patients and 15% needed at least two treatment sessions. Evaluated per procedure, a complete Stone removal was accomplished in 67% of all examinations (including initial and repeated procedures), while an incomplete Stone removal was observed in 33% of cases. The per procedure analyzes revealed that the success rates for a complete Stone removal were similar between LL and EHL (66% vs. 68%; p = 0.87). Complications, such as postinterventional cholangitis and pancreatitis occurred in 16% of examinations; however, except from one case, all were mild or moderate and no procedure-associated mortality occurred. Digital SOVC-assisted Biliary Stone treatment is highly effective even in cases with difficult Biliary Stones and might be considered the new standard of care for these patients. Furthermore, mild up to moderate complications were intermittently observed which might document the complexity of our included cases.
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Safety, diagnostic accuracy and therapeutic efficacy of digital single-operator cholangioscopy
United European gastroenterology journal, 2018Co-Authors: Frank Lenze, Arne Bokemeyer, Dominik Bettenworth, Dina Gross, Tobias M. Nowacki, Hansjoerg UllerichAbstract:Digital single-operator cholangioscopes (digital SOCs), equipped with an improved image quality, have been recently introduced. The aim of this study is to evaluate the safety and diagnostic and therapeutic efficacy of digital SOCs (Spyglass™ DS). Sixty-seven digital SOC procedures performed between 2015 and 2017 were retrospectively analyzed. The most frequent indications for examination were indeterminate Biliary strictures (61.2%) and Biliary Stone Disease (23.9%). In 25 patients (37.3), visual findings predicted malignancy with a sensitivity of 88.9%, a specificity of 97.6%, a positive predictive value (PPV) of 96.0% and a negative predictive value (NPV) of 92.9%. For histological analysis, forceps biopsies were performed in 29 patients (43.2%). Compared with visual findings, forceps biopsies yield a lower diagnostic efficacy in diagnosing malignancy (sensitivity 62.5%, specificity 90.0%, PPV 90.9%, NPV 60.0%). Therapeutic interventions were performed in 19 patients with a technical success rate of 89.4%. Adverse events were observed in 17 patients (25.4%). Of these, 11 patients (16.4%) suffered from severe adverse events (pancreatitis, cholangitis or major bleeding), which led to a prolonged hospital stay. Digital SOCs have excellent diagnostic and therapeutic efficacies, but are accompanied by high rates of adverse events; therefore, physicians should use digital SOCs in carefully selected cases.