EFFICACY OF CHOLANGIOSCOPIC DELIVERED ELECTROHYDRAULIC LITHOTRIPSY IN A TERTIARY REFERRAL UNIT

IntroductionCholangioscopy with electrohydraulic lithotripsy (EHL) is an evolving service to treat choledocholithiasis refractory to standard ERCP and is included in the BSG guidelines. We aimed to assess the safety, efficacy and implications of a new tertiary Spyglass EHL service for treatment of refractory gallstone disease.MethodsA review of prospectively collected data was performed for all EHL Spyglass procedures performed from 01.12.2018 to 31.12.2019 at St Thomas’ Hospital. Procedural duration was determined by the time between first and last fluoroscopic image taken. Stone burden was assessed by examination of fluoroscopic images. ERCP Spyglass DS1 and Autolith Touch II EHL Generator was used for all procedures.Results57 Spyglass EHL procedures were performed between January 2018 and December 2019 on 40 patients (75% females, 25% males with a mean age of 65). All cases had failed stone clearance at standard ERCP prior to this. Mean diameter of the largest stone was 1.83cm with a range of 1-3.5cm. All stones were < 2cm in patients who achieved ductal clearance in 1 procedure. Out of 40 patients, 9 were excluded as they were awaiting further EHL for duct clearance. 31/31 (100%) achieved ductal clearance at the last procedure. Ductal clearance was achieved with 1 EHL session in 11/31(35.5%), 2 EHL sessions in 11/31(35.5%), 3 EHL sessions in 7/31(23%) and 4 sessions in 2/31(6%). There was no correlation between number of stones and number or duration of EHL sessions. The average number of shocks used in one EHL was 1600 shocks. Average time spent on one EHL was 78 minutes. In 2018, 37.1 hours were used for Spyglass EHL in total (this does not include diagnostic Spyglass procedures). Documented complications occurred in 2/57(3.5%) procedures; 1 peri-pancreatic abscess with necrotic nodes and 1 lingual haematoma secondary to intubation. There were no reported cases of pancreatitis or 30 day mortality.ConclusionsCholangioscopy with EHL is an effective treatment for refractory choledocolithiasis, achieving 100% ductal clearance, with a low rate of complications. However the procedural duration and number of repeat procedures required based on stones size/burden is difficult to predict. This data will be useful to centres planning to roll out a Spyglass-EHL service.