BACKGROUND/AIMS: Electrohydraulic lithotripsy (EHL) under endoscopic retrograde cholangiopancreatography (ERCP) guidance can be an option to treat difficult stones. Recently, a digital, single-operator cholangioscope (SPY-DS) has become available. Peroral transluminal cholangioscopy (PTLC) using SPY-DS has also been reported. In this retrospective study, the technical feasibility and clinical effectiveness of EHL for difficult bile duct stones under ERCP guidance and under PTLC guidance was examined. METHODS: In this pilot study, patients with difficult bile duct stones between July 2016 and July 2017 were retrospectively enrolled. RESULTS: Forty-two consecutive patients underwent EHL using a SPY-DS; 34 patients underwent EHL under ERCP guidance, and the other 8 patients underwent EHL under PTLC guidance. Median procedure time was 31 minutes (range, 19 to 66 minutes). The median number of EHL sessions was 1 (range, 1 to 2), and that of ERCP sessions was also 1 (range, 1 to 3). The rate of complete stone clearance was 98% (41/42). Adverse events such as cholangitis and acute pancreatitis were seen in 14% (6/42), which could be treated conservatively. CONCLUSIONS: EHL using SPY-DS was technically feasible, not only under ERCP guidance, but also PTLC guidance. A prospective clinical study of EHL using SPY-DS is needed.
Bile Ducts* ; Bile* ; Cholangiopancreatography, Endoscopic Retrograde* ; Cholangitis ; Clinical Study ; Common Bile Duct ; Humans ; Lithotripsy* ; Pancreatitis ; Pilot Projects ; Prospective Studies ; Retrospective Studies ; Treatment Outcome

Spinal cord injury (SCI) is a main concern in patients who undergo thoracic endovascular therapy (TEVAR), because the blood flow of the vertebro-basilar artery may be reduced due to the left subclavian artery (LSA) occlusion. If the left vertebral artery originates directly from the aorta, which is called the isolated left vertebral artery (ILVA), a technical consideration for strategies regarding blood perfusion of the ILVA during TEVARs is required. We hereby aim to report three patients (No.1, No.2, and No.3) who underwent an ILVA translocation and TEVAR with Zone 2 landing for aortic dissection. The diameter of the ILVA was 4.2, 2.3, and 2.2 mm, respectively, and the right vertebral artery (RVA) was dominant in all cases. In Patient No.1 and No.2 (ILVA diameter: 4.2 and 2.3 mm, respectively), the ILVA was anastomosed directly to the left common carotid artery. In Patient No.2, the translocated ILVA was occluded resulting in SCI, but the SCI improved when blood pressure was augmented. In Patient No.3 (ILVA diameter: 2.2 mm), the saphenous vein graft was interposed between the ILVA and the bypass artery because the ILVA diameter was small, but postoperatively, the ILVA remained patent, and no paraplegia was observed. The occlusion of ILVA could cause SCI, even if the RVA is larger than the LVA. Reconstruction of the ILVA is a critical procedure to prevent postoperative SCIs in patients undergoing TEVARs.