https://www.gastrojournal.org/article/0016-5085(90)90026-W/pdf

Follow-up 6 to 11 years after duodenoscopic sphincterotomy for stones in patients with prior cholecystectomy.

https://www.giejournal.org/article/S0016-5107(98)70214-7/pdf

Randomized study of intracorporeal laser lithotripsy versus extracorporeal shock-wave lithotripsy for difficult bile duct stones

AIM: The usual bile duct stone may be removed by means of Dormia basket or balloon catheter, and results are quite good. However, the degree of difficulty is increased when stones are larger. Studies on the subject reported many cases where mechanical lithotripsy is combined with a second technique, e.g., electrohydraulic lithotripsy (EHL), where stones are crushed using baby-mother scope electric shock. The extracorporeal shock-wave lithotripsy (ESWL) or laser lithotripsy also yields an excellent success rate of greater than 90%. However, the equipment for these techniques are very expensive; hence we opted for the simple mechanical lithotripsy and evaluated its performance.

METHODS: During the period from August 1996 to December 2002, Mackay Memorial Hospital treated 304 patients suffering from difficult bile duct stones (stone >1.5 cm or stones that could not be removed by the ordinary Dormia basket or balloon catheter). These patients underwent endoscopic papillotomy (EPT) procedure, and stones were removed by means of the Olympus BML-4Q lithotripsy. A follow-up was conducted on the post-treatment conditions and complications of the patients.

RESULTS: Out of the 304 patients, bile duct stones were successfully removed from 272 patients, a success rate of about 90%. The procedure failed in 32 patients, for whom surgery was needed. Out of the 272 successfully treated patients, 8 developed cholangitis, 21 developed pancreatitis, and 10 patients had delayed bleeding, and no patient died. Among these 272 successful removal cases, successful bile duct stone removal was achieved after the first lithotripsy in 211 patients, whereas 61 patients underwent multiple sessions of lithotripsy. As for the 61 patients that underwent multiple sessions of mechanical lithotripsy, 6 (9.8%) had post-procedure cholangitis, 12 (19.6%) had pancreatitis, and 9 patients (14.7%) had delayed bleeding. Compared with the 211 patients undergoing a single session of mechanical lithotripsy, 3 (1.4%) had cholangitis, 1 (0.4%) had delayed bleeding, and 7 patients (3.3%) had pancreatitis. Statistical deviation was present in post-procedure cholangitis, delayed bleeding, and pancreatitis of both groups.

CONCLUSION: Mechanical bile stone lithotripsy on difficult bile duct stones could produce around 90% successful rate. Moreover, complications are minimal. This finding further confirms the significance of mechanical lithotripsy in the treatment of patients with difficult bile duct stones.

Outcome of simple use of mechanical lithotripsy of difficult common bile duct stones.

Endoscopic laser lithotripsy of large bile duct stones

Background Mechanical lithotripsy for the management of difficult common bile duct stones has sometimes yielded conflicting results. Methods A series of 162 consecutive patients who underwent mechanical lithotripsy was evaluated retrospectively and a large number of variables tested for their association with successful outcome. Results The procedure was safe (morbidity rate 1.8 per cent) and effective (84.0 per cent stone clearance rate). Univariate and multivariate analysis showed that stone size was the only outcome predictor (mean(s.d.) diameter of grasped versus non-grasped stones 21.7(6.7) versus 28.3(10.4) mm; F = 10.72, 98 d.f., P = 0.002). The cumulative probability of bile duct clearance ranged from over 90 per cent for stones with a diameter less than 10 mm to 68 per cent for those greater than 28 mm in diameter (P < 0.02). Conclusion Patients at high risk of lithotripsy failure (stone diameter of 28 mm or more) might more wisely undergo surgery or other non-surgical procedures, such as extracorporeal shock-wave lithotripsy or long-term biliary stenting.

Endoscopic mechanical lithotripsy of difficult common bile duct stones.

At present, video endoscopic systems (VE) are available from four companies. We have had an opportunity to test these instruments in clinical practice. In principle, all the VE's are similar in that they employ charge coupling devices (CCD-chips) as image sensors, but they differ significantly in CCD chip technology and in the color acquisition technique. The basic aspects of CCD chip and transmission technology of relevance to the endoscopist are discussed. The mechanical properties of the endoscopes are listed. Finally, we provide an outlook on the determinants of the optical performance of VE's. The optical performance of a VE can be characterized by its resolution and color performance.

Electronic Endoscopy - The Latest Technology

Electronic endoscopy has undergone considerable evolution in recent years. Early instruments had poorer resolution than fiberscopes, and distorted colors significantly. The second generation of electronic endoscopes has been considerably improved, and electronic endoscopy is expected to play a major role in endoscopy in the next decade, with its enhanced teaching abilities, permanent image storage, reproduction and retrieval. An important new development has been the development of a high-resolution colonoscope & gastroscope. Electronic endoscopes are now able to produce better resolution than fiberscopes, and the future should bring further improvements in resolution with electronic instruments. A number of problems still remain to be solved with electronic endoscopy. Irregular reflection from secretions, food and blood at short focus (less than 1 cm) results in a loss of resolution, which makes electronic endoscopy particularly difficult when bleeding is brisk. Electronic endoscopes synthesize color from a strobed signal of red, blue and green in a processor. Color is dependent on brightness, and at close focus, excessive brightness in the center of the field results in erratic color reproduction. Images acquired at electronic endoscopy may be digitized for storage and processing in a computer--which, however, is not a straightforward task at the present time. Image processing in electronic endoscopy is still in its early stages, but we anticipate that new developments in early diagnosis, classification and measurement of lesions will take place. Digitized images can also be transmitted via telephone lines, and it will soon be possible to instantaneously send images across the world.

Perspectives in "electronic endoscopy". Past, present and future of fibers and CCDs in medical endoscopes.

We have conducted a study aimed at testing the color performance of video endoscopes in quantitative terms for the first time. The video endoscopes investigated were from Fuji, Olympus, Toshiba/Machida, and Welch-Allyn. The tests were carried out with an opto-electronic color analyser using standardized color charts and a neutral grey chart. Hue and chroma of the reproduced colors were measured. The Olympus video endoscope reproduces the hue very well, showing only slight color desaturation. The Fuji video endoscope had a yellowish tint, whereas the picture obtained with the WA video endoscope produced an inhomogeneous picture with a pronounced red/purplish cast at the top of the screen and almost neutral reproduction at the lower half. The Toshiba video endoscope was the only one with a color chip, and reproduced hue fairly well, but its colors were weakly saturated.

Color performance of video endoscopes: quantitative measurement of color reproduction.

The subject of this study was the optical performance of video-endoscopic systems (VE) in terms of maximal resolving power and resolvable picture elements. Olympus, Toshiba/Machida, Fujinon, and Welch Allyn video gastroscopes were tested. A GIF Q 10 fiberscope from Olympus was also included for comparison. The resolution measurements were made at various distances using two independent methods--electronic analysis of the TV signal, and visual evaluation of the resolution, of a standardized test target. The results obtained with the two methods were in perfect agreement. The resolution of fine details clearly depends on the distance between the distal end and the target because of decreasing image scale. Depending on the individual optical design, the various VE's show maxima at different distances. At shorter distances, the image is degraded by defocusing. An optimal distance which is as small as possible is desired for clinical routine. Apart from the fiberscope this requirement is best met by the Fuji system. The greatest resolution is obtained with the Toshiba system but at the cost of the viewing angle which is the smallest of all the systems. Fuji combines relatively high resolution with a large viewing angle. Because of the widely varying viewing angle a comparison based solely on resolution cannot represent the true imaging capability of the system. We therefore eliminated purely optical parameters and calculated the number of resolvable picture elements per line. We regard this number to be a fair characterization of both TV and fiber systems.

Video-endoscopes in comparison with fiberscopes: quantitative measurement of optical resolution

Treatment of stones in the bile duct via duodenoscopy.

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