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Long-term follow-up after peroral cholangioscopy-directed lithotripsy in patients with difficult bile duct stones, including Mirizzi syndrome: an analysis of risk factors predicting stone recurrence

Peroral cholangioscopy-directed lithotripsy (PC-directed lithotripsy) has been successfully used for the treatment of difficult bile duct stones, including Mirizzi syndrome (MS). However, long-term outcome and risk factors for stone recurrence after PC-directed lithotripsy have not yet been elucidated. The aim of this study was to assess the outcomes of long-term follow-up after PC-directed lithotripsy and to clarify risk factors predicting stone recurrence.

One hundred twenty-two consecutive patients with difficult bile duct stones, including MS type II (McSherry classification system), were included in the study.

Successful stone removal was achieved in 117 (95.9%) of the 122 patients treated with PC-directed lithotripsy. Of these 117 patients, reliable follow-up information for a median period of 5.5 years (range = 0.19–16.6) was obtained for 111 patients (94.9%) in whom stone type was classified into one of the following three categories: (1) MS type II (47 patients); (2) impacted stones (45 patients); and (3) large stones (≥20 mm in short diameter, 19 patients). Bile duct stone recurrence was observed in 18 patients (16.1%), of whom 4 had MS type II, 9 had impacted stones, and 5 had large stones. Statistical analysis showed that dilated bile duct diameter greater than or equal to 20 mm was the only risk factor for stone recurrence.

PC-directed lithotripsy used for the treatment of difficult bile duct stones, including MS type II and impacted stones, and is found to be safe at long-term follow-up. Dilated bile duct diameter is the only risk factor for stone recurrence. Careful follow-up is indispensable, particularly for patients with dilated bile ducts.

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PC:

Peroral cholangioscopy

MS:

Mirizzi syndrome

ML:

Mechanical lithotripsy

ERCP:

Endoscopic retrograde cholangiopancreatography

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Drs. Tsuyuguchi, Sakai, Sugiyma, Ishihara, and Yokosuka have no conflicts of interest or financial ties to disclose.

1. Department of Gastroenterology and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan

   Toshio Tsuyuguchi, Yuji Sakai, Harutoshi Sugiyama, Takeshi Ishihara & Osamu Yokosuka

1. Toshio Tsuyuguchi
2. Yuji Sakai
3. Harutoshi Sugiyama
4. Takeshi Ishihara
5. Osamu Yokosuka

Correspondence to Toshio Tsuyuguchi.

Tsuyuguchi, T., Sakai, Y., Sugiyama, H. et al. Long-term follow-up after peroral cholangioscopy-directed lithotripsy in patients with difficult bile duct stones, including Mirizzi syndrome: an analysis of risk factors predicting stone recurrence. Surg Endosc 25, 2179–2185 (2011). https://doi.org/10.1007/s00464-010-1520-1

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• Received: 01 July 2010

• Accepted: 27 November 2010

• Published: 24 December 2010

• Issue Date: July 2011

• DOI: https://doi.org/10.1007/s00464-010-1520-1

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