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Endoscopy
Endoscopy
10.1055/s-00000012
Endoscopy
Endoscopy
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10.1055/a-2376-5834
E-Videos-2024-02-4850-EV
E-Videos
Direct visualization system combined with endoscopic retrograde cholangiopancreatography for treatment of choledocholithiasis complicated by multiple gallstones
http://orcid.org/0000-0002-1487-1507
Zhang Wei
Zhang Lichao Dr.
Hou Sen-Lin MD
1 71213 Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
Correspondence Sen-Lin Hou, MD Department of Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University215 Heping West RoadShijiazhuang City, Hebei Province, 050000Chinahousenlin@hebmu.edu.cn
04 9 2024
12 2024
1 9 2024
56 Suppl 1 E753E754
The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
2024
The Author(s).
https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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pmcDirect visualization system combined with endoscopic retrograde cholangiopancreatography for treatment of choledocholithiasis complicated by multiple gallstones.

Currently, the first-line treatment for multiple gallstones with choledocholithiasis is endoscopic retrograde cholangiopancreatography (ERCP) combined with cholecystectomy. However, many patients do not proceed with cholecystectomy after ERCP. In particular, young patients often have a strong preference for preserving the gallbladder. We developed a method to remove gallstones by utilizing the natural cavity pathways of the human body.

A 30-year-old woman was hospitalized with choledocholithiasis and gallstones ( Fig. 1 ) for gallbladder-preserving lithotomy after ERCP. First, we performed ERCP to remove the common bile duct (CBD) stones. Then, we inserted a plastic stent in the CBD to prevent obstructive jaundice after the placement of a fully covered metal stent in the cystic duct of the gallbladder. Next, a fully covered metal stent with a diameter of 10 mm and a length of 12 cm was placed in the cystic duct of the gallbladder ( Fig. 1 ). Three days later, we performed ERCP-based cholecystolithotomy assisted by the eyeMax direct visualization system. Finally, the stents were gradually removed, the gallbladder cavity was irrigated ( Fig. 1 ), and an external drainage tube was placed inside the gallbladder. After 2 days, the tube was removed. The patient experienced no complications. We followed up the patient for 10 months, during which no gallstones were found on abdominal ultrasound ( Video 1 ).

Fig. 1 a, b Computed tomography images showing multiple gallstones ( a ) and choledocholithiasis ( b ). c A fully covered metal stent was inserted into the neck of the gallbladder (yellow arrow indicates the tip of the stent). d A metal stent was used to dilate the narrow cystic duct (red circle). e The metal stent is seen in the cystic duct 3 days after dilation. f After the gallstones were removed, the gallbladder cavity was irrigated with normal saline under guidance of the eyeMax direct visualization system.

Gallstones were extracted using a basket and a fully covered metal stent under the guidance of the eyeMax direct visualization system.

Video 1

The preferred treatment for choledocholithiasis with cholecystolithiasis is ERCP combined with cholecystectomy 1 . However, in certain cases where cholecystectomy cannot be performed, gallbladder-preserving cholecystolithotomy is a safe and effective alternative 2 3 . Extraction of cholecystolithiasis through physiological passages is less invasive. The use of a fully covered metal stent facilitates repeated access to the gallbladder. Additionally, the eyeMax direct visualization system enhances the intuitive nature of the surgery and improves the accuracy of stone collection using baskets. We recommend this procedure for the management of selected patients with gallstones.

Endoscopy_UCTN_Code_TTT_1AR_2AH

Endoscopy E-Videos https://eref.thieme.de/e-videos

E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos .

Conflict of Interest The authors declare that they have no conflict of interest.
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References

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2 Qu Q Chen W Liu X Role of gallbladder-preserving surgery in the treatment of gallstone diseases in young and middle-aged patients in China: results of a 10-year prospective study Surgery 2020 167 283 289 10.1016/j.surg.2019.09.001 31606197
3 Gallbladder-Preserving Surgery Committee Endoscopy Specialist Branch of Chinese Medical Doctor Association The Endoscopy Specialist Branch of Chinese Medical Doctor Association. The clinical guideline for choledochoscopic gallbladder-preserving surgery China J Endosc 2021 27 21 29
