{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T10:39:08Z","timestamp":1792665548834,"version":"4.5.0"},"reference-count":16,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Hepato Biliary Pancreat"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Peroral cholangioscopy\u2010guided lithotripsy (POCS\u2010L) has emerged as a treatment option for difficult bile duct stones (DBDSs), but detailed evidence remains limited. This study evaluated its effectiveness, safety, and risk factors for adverse events (AEs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 132 consecutive patients who underwent POCS\u2010L for DBDSs between December 2014 and July 2023 at Tokyo Medical University Hospital. Electrohydraulic lithotripsy or holmium: yttrium\u2010aluminum\u2010garnet laser lithotripsy was performed under cholangioscopic guidance. The primary outcomes were technical and clinical success, and secondary outcomes included procedure\u2010associated AEs and risk factors for cholangitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The technical and clinical success rates were 98.5% and 94.7%, respectively, with a median procedure time of 56\u2009min. Clinical success was higher for common bile duct stones than intrahepatic bile duct stones (98.0% vs. 83.9%). Procedure\u2010associated AEs occurred in 29.5% of patients, most commonly transient fever (16.7%) and cholangitis (11.4%). Multivariable analysis identified a stone diameter &gt;\u200920\u2009mm (odds ratio [OR]: 4.79;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.016) and absence of postprocedural biliary drainage (OR: 3.73;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.048) as independent predictors of cholangitis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>POCS\u2010L is an effective and safe treatment for DBDSs. Postprocedural biliary drainage may reduce the risk of cholangitis, particularly in patients with large stones.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jhbp.70138","type":"journal-article","created":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T06:24:51Z","timestamp":1780122291000},"page":"789-794","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Evaluation of the Effectiveness of Digital Peroral Cholangioscopy\u2010Guided Lithotripsy for Difficult Bile Duct Stones"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0246-2105","authenticated-orcid":false,"given":"Hirohito","family":"Minami","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuntaro","family":"Mukai","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayoshi","family":"Tsuchiya","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reina","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Tonozuka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazumasa","family":"Nagai","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Kojima","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriyuki","family":"Hirakawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyoko","family":"Asano","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takao","family":"Itoi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University  Tokyo 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