A new hybrid anchoring balloon for direct peroral cholangioscopy using an ultraslim upper endoscope.
BACKGROUND AND AIM
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 six 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, 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 failed within 25 min. Mean time for technical success by our method was 12.4 ± 3.4 min. In total, of the 43 cases with previous removal of CBD stones, seven (16.3%) were found to have residual stones ≥4 mm, excluding three cases in whom direct POC failed. In another 25 cases for difficult stones, 24 lithotripsies were carried out, resulting in 23 complete fragmentations. No significant procedure-related complications were observed.


CONCLUSION
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.
['Li|Jian|J|', 'Guo|Shao-Ju|SJ|', 'Zhang|Jing-Chao|JC|', 'Wang|Hong-Yan|HY|', 'Li|Kai|K|', 'Niu|She-Hui|SH|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D019723:Endoscopes D016145:Endoscopy, Digestive System D004867:Equipment Design D005260:Female D042882:Gallstones D006801:Humans D008297:Male D008875:Middle Aged D057605:Natural Orifice Endoscopic Surgery D012189:Retrospective Studies D055815:Young Adult
hybrid anchoring balloon peroral cholangioscopy ultraslim endoscope residual stone difficult stone