In this editorial,we comment on the article by Ye et al.We specifically focused on the novel use of DynaCT biliary soft tissue reconstruction technology in the diagnosis and treatment of hepatolithiasis with bile duct...In this editorial,we comment on the article by Ye et al.We specifically focused on the novel use of DynaCT biliary soft tissue reconstruction technology in the diagnosis and treatment of hepatolithiasis with bile duct stenosis,which is an innovative approach for enhancing the preoperative evaluation and surgical outcomes in hepatolithiasis.This study also highlights the limitations of conventional imaging techniques such as computed tomography and magnetic resonance cholangiopancreatography,which have low sensitivity for small stones and complex biliary strictures.Given the intricate anatomy of the biliary system and the challenges posed by limited visualization using conventional methods,DynaCT addresses these issues by providing high-resolution,three-dimensional reconstruction of the bile ducts,stones,and vascular structures,thus improving anatomical clarity and enabling precise surgical planning.We also focused specifically on the limitations of DynaCT,such as the need for specialized equipment and patient selection criteria,as well as its advantages and disadvantages compared with conventional PTOBF approaches.Overall,DynaCT represents a significant advancement in hepatolithiasis management,with the potential to become a standard imaging modality for safer and more effective biliary procedures.展开更多
BACKGROUND Hepatobiliary stone disease involves an intrahepatic bile duct stone that occurs above the confluence of the right and left hepatic ducts.One-step percutaneous transhepatic cholangioscopic lithotripsy(PTCSL...BACKGROUND Hepatobiliary stone disease involves an intrahepatic bile duct stone that occurs above the confluence of the right and left hepatic ducts.One-step percutaneous transhepatic cholangioscopic lithotripsy(PTCSL)using the percutaneous transhepatic one-step biliary fistulation(PTOBF)technique enables the clearing of intrahepatic stones and the resolution of strictures.However,hepatolithiasis with associated strictures still has high residual and recurrence rates after one-step PTCSL.DynaCT can achieve synchronized acquisition with a flat-panel detector during C-arm rotation.The technical approach and application value of DynaCT biliary soft tissue reconstruction technology for the diagnosis and treatment of hepatolithiasis with bile duct stenosis were evaluated in this study.AIM To explore the value of DynaCT biliary soft tissue reconstruction technology for the diagnosis and treatment of hepatolithiasis with bile duct stenosis,and to assess the feasibility and effectiveness of the PTOBF technique guided by DynaCT biliary soft tissue reconstruction technology.METHODS The clinical data of 140 patients with complex biliary stenosis disease combined with bile duct stenosis who received PTOBF and were admitted to the First Affiliated Hospital of Guangzhou Medical University from January 2020 to December 2024 were collected.The patients were divided into two groups:DynaCT-PTOBF group(70 patients)and conventional PTOBF group(70 patients).These groups were compared in terms of the preoperative bile duct stenosis,location of the liver segment where the stone was located,intraoperative operative time,immediate stone retrieval rate,successful stenosis dilatation rate,postoperative complication rate,postoperative reoperation rate,stone recurrence rate,and stenosis recurrence rate.RESULTS DynaCT biliary soft tissue reconstruction technology was successfully performed in 70 patients.The DynaCTPTOBF group had a higher detection rate of target bile ducts where bile duct stones and biliary strictures were located than the PTOBF group.Compared with the PTOBF group,the DynaCT-PTOBF group was characterized by a significantly greater immediate stone removal rate(68.6%vs 50.0%,P=0.025),greater immediate stenosis dilatation success rate(72.9%vs 55.7%,P=0.034),greater final stenosis release rate(91.4%vs 75.7%,P=0.012),shorter duration of intraoperative hemorrhage(3.14±2.00 vs 26.5±52.1,P=0.039),and lower incidence of distant cholangitis(2.9%vs 11.4%,P=0.49).There were no significant differences between the two groups in terms of the final stone removal rate,reoperation rate,or long-term complication incidence rate.CONCLUSION DynaCT biliary soft tissue reconstruction technology guiding the PTOBF technique in patients with hepatolithiasis with bile duct stenosis is feasible and accurate.It may be beneficial for optimizing the preoperative evaluation of the PTOBF technique.展开更多
Peroral cholangioscopy is an important tool for diagnosis and treatment of various biliary disorders. Peroral cholangioscopy can be performed by using a dedicated cholangioscope that is advanced through the accessory ...Peroral cholangioscopy is an important tool for diagnosis and treatment of various biliary disorders. Peroral cholangioscopy can be performed by using a dedicated cholangioscope that is advanced through the accessory channel of a duodenoscope, or by direct insertion of a small-diameter endoscope into the bile duct. Direct peroral cholangioscopy refers to insertion of an ultraslim endoscope directly into the bile duct for visualization of the biliary mucosa and lumen. This approach provides a valuable and economic solution for diagnostic and therapeutic applications in the biliary tree. Compared to ductoscopy using a dedicated cholangioscope, the direct approach has several advantages and disadvantages. In this editorial, I discuss the advantages, disadvantages, and possible future developments pertaining to direct peroral cholangioscopy.展开更多
BACKGROUND Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide.Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional mul...BACKGROUND Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide.Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional multisession percutaneous transhepatic cholangioscopic lithotripsy(PTCSL).AIM To study one-step PTCSL using the percutaneous transhepatic one-step biliary fistulation(PTOBF)technique guided by three-dimensional(3D)visualization.METHODS This was a retrospective,single-center study analyzing,140 patients who,between October 2016 and October 2023,underwent one-step PTCSL for hepatolithiasis.The patients were divided into two groups:The 3D-PTOBF group and the PTOBF group.Stone clearance on choledochoscopy,complications,and long-term clearance and recurrence rates were assessed.RESULTS Age,total bilirubin,direct bilirubin,Child-Pugh class,and stone location were similar between the 2 groups,but there was a significant difference in bile duct strictures,with biliary strictures more common in the 3D-PTOBF group(P=0.001).The median follow-up time was 55.0(55.0,512.0)days.The immediate stone clearance ratio(88.6%vs 27.1%,P=0.000)and stricture resolution ratio(97.1%vs 78.6%,P=0.001)in the 3D-PTOBF group were significantly greater than those in the PTOBF group.Postoperative complication(8.6%vs 41.4%,P=0.000)and stone recurrence rates(7.1%vs 38.6%,P=0.000)were significantly lower in the 3D-PTOBF group.CONCLUSION Three-dimensional visualization helps make one-step PTCSL a safe,effective,and promising treatment for patients with complicated primary hepatolithiasis.The perioperative and long-term outcomes are satisfactory for patients with complicated primary hepatolithiasis.This minimally invasive method has the potential to be used as a substitute for hepatobiliary surgery.展开更多
Biliary strictures are considered indeterminate when basic work-up, including transabdominal imaging and endoscopic retrograde cholangiopancreatography with routine cytologic brushing, are non-diagnostic. Indeterminat...Biliary strictures are considered indeterminate when basic work-up, including transabdominal imaging and endoscopic retrograde cholangiopancreatography with routine cytologic brushing, are non-diagnostic. Indeterminate biliary strictures can easily be mischaracterized which may dramatically affect patient's outcome. Early and accurate diagnosis of malignancy impacts not only a patient's candidacy for surgery, but also potential timely targeted chemotherapies. A significant portion of patients with indeterminate biliary strictures have benign disease and accurate diagnosis is, thus, paramount to avoid unnecessary surgery. Current sampling strategies have suboptimal accuracy for the diagnosis of malignancy. Emerging data on other diagnostic modalities, such as ancillary cytology techniques, single operator cholangioscopy, and endoscopic ultrasonography-guided fine needle aspiration, revealed promising results with much improved sensitivity.展开更多
Objective To access the therapeutic efficacy of newly-designed digital cholangioscope-assisted bedside one-stage lithotomy and biliary drainage for severe acute cholangitis caused by choledocholithiasis.Methods Data o...Objective To access the therapeutic efficacy of newly-designed digital cholangioscope-assisted bedside one-stage lithotomy and biliary drainage for severe acute cholangitis caused by choledocholithiasis.Methods Data of 26 patients were retrospectively analyzed,who were admitted into the intensive care unit(ICU),Zhongda Hospital,Southeast University,due to choledocholithiasis induced by severe acute cholangitis and underwent cholangioscope-assisted bedside one-stage lithotomy and biliary drainage from June 2020 to February 2022.Clinical outcomes were analyzed.Results The time interval from disease onset to endoscopic intervention was 36.2±15.5 hours,with 7.2±4.9 hours from ICU admission to endoscopic intervention.Technical success rate was 100.0%in one-stage stone removal and biliary drainage.Except for one mild pancreatitis,no other complications occurred.Acute physiology and chronic health evaluation(APACHE)II and sequential organ failure assessment(SOFAs)cores prior to endoscopic intervention were 25.2±6.6 and 11.9±3.5,respectively.APACHE II scores at day 1,3,and 7 after endoscopic intervention were 21.7±6.5,17.2±6.8 and 12.7±7.7,respectively,and SOFA scores were 10.6±2.9,8.4±3.0 and 5.4±3.7,respectively,all of which were lower than those before operation(P<0.001).The length of ICU stay and total hospitalization was 9.7±5.0 days and 12.8±4.5 days,respectively.In-hospital mortality occurred in 3(11.5%)patients.According to a 6-month follow-up,one patient died of pneumonia,and another died of acute myocardial infarction.No acute cholangitis re-occurred in those survivors.Conclusion Newly-designed digital cholangioscope-assisted bedside one-stage lithotomy and biliary drainage demonstrate significant improvements in prognosis,highlighting its safety in managingsevere acute cholangitis.展开更多
文摘In this editorial,we comment on the article by Ye et al.We specifically focused on the novel use of DynaCT biliary soft tissue reconstruction technology in the diagnosis and treatment of hepatolithiasis with bile duct stenosis,which is an innovative approach for enhancing the preoperative evaluation and surgical outcomes in hepatolithiasis.This study also highlights the limitations of conventional imaging techniques such as computed tomography and magnetic resonance cholangiopancreatography,which have low sensitivity for small stones and complex biliary strictures.Given the intricate anatomy of the biliary system and the challenges posed by limited visualization using conventional methods,DynaCT addresses these issues by providing high-resolution,three-dimensional reconstruction of the bile ducts,stones,and vascular structures,thus improving anatomical clarity and enabling precise surgical planning.We also focused specifically on the limitations of DynaCT,such as the need for specialized equipment and patient selection criteria,as well as its advantages and disadvantages compared with conventional PTOBF approaches.Overall,DynaCT represents a significant advancement in hepatolithiasis management,with the potential to become a standard imaging modality for safer and more effective biliary procedures.
文摘BACKGROUND Hepatobiliary stone disease involves an intrahepatic bile duct stone that occurs above the confluence of the right and left hepatic ducts.One-step percutaneous transhepatic cholangioscopic lithotripsy(PTCSL)using the percutaneous transhepatic one-step biliary fistulation(PTOBF)technique enables the clearing of intrahepatic stones and the resolution of strictures.However,hepatolithiasis with associated strictures still has high residual and recurrence rates after one-step PTCSL.DynaCT can achieve synchronized acquisition with a flat-panel detector during C-arm rotation.The technical approach and application value of DynaCT biliary soft tissue reconstruction technology for the diagnosis and treatment of hepatolithiasis with bile duct stenosis were evaluated in this study.AIM To explore the value of DynaCT biliary soft tissue reconstruction technology for the diagnosis and treatment of hepatolithiasis with bile duct stenosis,and to assess the feasibility and effectiveness of the PTOBF technique guided by DynaCT biliary soft tissue reconstruction technology.METHODS The clinical data of 140 patients with complex biliary stenosis disease combined with bile duct stenosis who received PTOBF and were admitted to the First Affiliated Hospital of Guangzhou Medical University from January 2020 to December 2024 were collected.The patients were divided into two groups:DynaCT-PTOBF group(70 patients)and conventional PTOBF group(70 patients).These groups were compared in terms of the preoperative bile duct stenosis,location of the liver segment where the stone was located,intraoperative operative time,immediate stone retrieval rate,successful stenosis dilatation rate,postoperative complication rate,postoperative reoperation rate,stone recurrence rate,and stenosis recurrence rate.RESULTS DynaCT biliary soft tissue reconstruction technology was successfully performed in 70 patients.The DynaCTPTOBF group had a higher detection rate of target bile ducts where bile duct stones and biliary strictures were located than the PTOBF group.Compared with the PTOBF group,the DynaCT-PTOBF group was characterized by a significantly greater immediate stone removal rate(68.6%vs 50.0%,P=0.025),greater immediate stenosis dilatation success rate(72.9%vs 55.7%,P=0.034),greater final stenosis release rate(91.4%vs 75.7%,P=0.012),shorter duration of intraoperative hemorrhage(3.14±2.00 vs 26.5±52.1,P=0.039),and lower incidence of distant cholangitis(2.9%vs 11.4%,P=0.49).There were no significant differences between the two groups in terms of the final stone removal rate,reoperation rate,or long-term complication incidence rate.CONCLUSION DynaCT biliary soft tissue reconstruction technology guiding the PTOBF technique in patients with hepatolithiasis with bile duct stenosis is feasible and accurate.It may be beneficial for optimizing the preoperative evaluation of the PTOBF technique.
文摘Peroral cholangioscopy is an important tool for diagnosis and treatment of various biliary disorders. Peroral cholangioscopy can be performed by using a dedicated cholangioscope that is advanced through the accessory channel of a duodenoscope, or by direct insertion of a small-diameter endoscope into the bile duct. Direct peroral cholangioscopy refers to insertion of an ultraslim endoscope directly into the bile duct for visualization of the biliary mucosa and lumen. This approach provides a valuable and economic solution for diagnostic and therapeutic applications in the biliary tree. Compared to ductoscopy using a dedicated cholangioscope, the direct approach has several advantages and disadvantages. In this editorial, I discuss the advantages, disadvantages, and possible future developments pertaining to direct peroral cholangioscopy.
基金Supported by The Key Medical Specialty Nurturing Program of Foshan During The 14th Five-Year Plan Period,No.FSPY145205The Medical Research Project of Foshan Health Bureau,No.20230814A010024+1 种基金The Guangzhou Science and Technology Plan Project,No.202102010251the Guangdong Science and Technology Program,No.2017ZC0222.
文摘BACKGROUND Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide.Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional multisession percutaneous transhepatic cholangioscopic lithotripsy(PTCSL).AIM To study one-step PTCSL using the percutaneous transhepatic one-step biliary fistulation(PTOBF)technique guided by three-dimensional(3D)visualization.METHODS This was a retrospective,single-center study analyzing,140 patients who,between October 2016 and October 2023,underwent one-step PTCSL for hepatolithiasis.The patients were divided into two groups:The 3D-PTOBF group and the PTOBF group.Stone clearance on choledochoscopy,complications,and long-term clearance and recurrence rates were assessed.RESULTS Age,total bilirubin,direct bilirubin,Child-Pugh class,and stone location were similar between the 2 groups,but there was a significant difference in bile duct strictures,with biliary strictures more common in the 3D-PTOBF group(P=0.001).The median follow-up time was 55.0(55.0,512.0)days.The immediate stone clearance ratio(88.6%vs 27.1%,P=0.000)and stricture resolution ratio(97.1%vs 78.6%,P=0.001)in the 3D-PTOBF group were significantly greater than those in the PTOBF group.Postoperative complication(8.6%vs 41.4%,P=0.000)and stone recurrence rates(7.1%vs 38.6%,P=0.000)were significantly lower in the 3D-PTOBF group.CONCLUSION Three-dimensional visualization helps make one-step PTCSL a safe,effective,and promising treatment for patients with complicated primary hepatolithiasis.The perioperative and long-term outcomes are satisfactory for patients with complicated primary hepatolithiasis.This minimally invasive method has the potential to be used as a substitute for hepatobiliary surgery.
文摘Biliary strictures are considered indeterminate when basic work-up, including transabdominal imaging and endoscopic retrograde cholangiopancreatography with routine cytologic brushing, are non-diagnostic. Indeterminate biliary strictures can easily be mischaracterized which may dramatically affect patient's outcome. Early and accurate diagnosis of malignancy impacts not only a patient's candidacy for surgery, but also potential timely targeted chemotherapies. A significant portion of patients with indeterminate biliary strictures have benign disease and accurate diagnosis is, thus, paramount to avoid unnecessary surgery. Current sampling strategies have suboptimal accuracy for the diagnosis of malignancy. Emerging data on other diagnostic modalities, such as ancillary cytology techniques, single operator cholangioscopy, and endoscopic ultrasonography-guided fine needle aspiration, revealed promising results with much improved sensitivity.
文摘Objective To access the therapeutic efficacy of newly-designed digital cholangioscope-assisted bedside one-stage lithotomy and biliary drainage for severe acute cholangitis caused by choledocholithiasis.Methods Data of 26 patients were retrospectively analyzed,who were admitted into the intensive care unit(ICU),Zhongda Hospital,Southeast University,due to choledocholithiasis induced by severe acute cholangitis and underwent cholangioscope-assisted bedside one-stage lithotomy and biliary drainage from June 2020 to February 2022.Clinical outcomes were analyzed.Results The time interval from disease onset to endoscopic intervention was 36.2±15.5 hours,with 7.2±4.9 hours from ICU admission to endoscopic intervention.Technical success rate was 100.0%in one-stage stone removal and biliary drainage.Except for one mild pancreatitis,no other complications occurred.Acute physiology and chronic health evaluation(APACHE)II and sequential organ failure assessment(SOFAs)cores prior to endoscopic intervention were 25.2±6.6 and 11.9±3.5,respectively.APACHE II scores at day 1,3,and 7 after endoscopic intervention were 21.7±6.5,17.2±6.8 and 12.7±7.7,respectively,and SOFA scores were 10.6±2.9,8.4±3.0 and 5.4±3.7,respectively,all of which were lower than those before operation(P<0.001).The length of ICU stay and total hospitalization was 9.7±5.0 days and 12.8±4.5 days,respectively.In-hospital mortality occurred in 3(11.5%)patients.According to a 6-month follow-up,one patient died of pneumonia,and another died of acute myocardial infarction.No acute cholangitis re-occurred in those survivors.Conclusion Newly-designed digital cholangioscope-assisted bedside one-stage lithotomy and biliary drainage demonstrate significant improvements in prognosis,highlighting its safety in managingsevere acute cholangitis.
