{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:29:31Z","timestamp":1792099771504,"version":"4.4.0"},"reference-count":0,"publisher":"Georg Thieme Verlag KG","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2002Peroral cholangioscopy (POCS) can be useful for difficult bile duct stone clearance. Large prospective multinational data on POCS-guided lithotripsy for clearing difficult bile duct stones in a single session of endoscopic retrograde cholangiopancreatography (ERCP) are missing.<\/jats:p><jats:p>\n          Methods\u2002Patients with difficult bile duct stones (defined as one or more of: largest stone diameter \u2265\u200a15\u200amm, failed prior attempt at stone clearance, impacted, multiple, hepatic duct location, or located above a stricture) were enrolled at 17 centers in 10 countries. The principal endpoint was stone clearance in a single ERCP procedure using POCS.<\/jats:p><jats:p>\n          Results\u2002156 patients underwent 174 sessions of POCS-guided electrohydraulic or laser lithotripsy. Stone clearance had failed in a previous ERCP using traditional techniques in 124\/156 patients (80\u200a%), while 32\u200a\/156 patients (21\u200a%) were referred directly to POCS-guided therapy based on preprocedural assessment of the difficulty of stone clearance. In 101\/156 patients (65\u200a%), there were impacted stones. POCS-guided stone clearance was achieved in a single POCS procedure in 125\u200a\/156 patients (80\u200a%, 95\u200a% confidence interval [CI] 73\u200a%\u200a\u2013\u200a86\u200a%), and was significantly more likely for stones \u2264\u200a30\u200amm compared with &gt;\u200a30\u200amm (odds ratio 7.9, 95\u200a%CI 2.4\u200a\u2013\u200a26.2; P\u200a=\u200a0.002). Serious adverse events occurred in 3\/156 patients (1.9\u200a%, 95\u200a%CI 0.4\u200a%\u200a\u2013\u200a5.5\u200a%), and included pancreatitis, perforation due to laser lithotripsy, and cholangitis (n\u200a=\u200a1 each), all resolved within 1 week.<\/jats:p><jats:p>\n          Conclusion\u2002POCS-guided lithotripsy is highly effective for clearance of difficult bile duct stones in a single procedure and successfully salvages most prior treatment failures. It may also be considered first-line therapy for patients with difficult choledocholithiasis to avoid serial procedures.<\/jats:p>","DOI":"10.1055\/a-0942-9336","type":"journal-article","created":{"date-parts":[[2019,6,28]],"date-time":"2019-06-28T00:04:16Z","timestamp":1561680256000},"page":"922-929","source":"Crossref","is-referenced-by-count":55,"title":["Cholangioscopy-guided lithotripsy for difficult bile duct stone clearance in a single session of ERCP: results from a large multinational registry demonstrate high success rates"],"prefix":"10.1055","volume":"51","clinical-trial-number":[{"clinical-trial-number":"nct02281019","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Amit P.","family":"Maydeo","sequence":"additional","affiliation":[{"name":"Baldota Institute of Digestive Sciences, Global Hospital, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rungsun","family":"Rerknimitr","sequence":"additional","affiliation":[{"name":"Chulalongkorn University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James Y.","family":"Lau","sequence":"additional","affiliation":[{"name":"Prince of Wales Hospital, Shatin, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulrahman","family":"Aljebreen","sequence":"additional","affiliation":[{"name":"King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saad K.","family":"Niaz","sequence":"additional","affiliation":[{"name":"Civil Hospital, Karachi, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takao","family":"Itoi","sequence":"additional","affiliation":[{"name":"Tokyo Medical University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiing Leong","family":"Ang","sequence":"additional","affiliation":[{"name":"Changi General Hospital, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Reichenberger","sequence":"additional","affiliation":[{"name":"Netcare Unitas Hospital, Pretoria, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Wan","family":"Seo","sequence":"additional","affiliation":[{"name":"Asan Medical Center, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohan K.","family":"Ramchandani","sequence":"additional","affiliation":[{"name":"Asian Institute of Gastroenterology, Hyderabad, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedict M.","family":"Devereaux","sequence":"additional","affiliation":[{"name":"University of Queensland Medical School, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong Kyun","family":"Lee","sequence":"additional","affiliation":[{"name":"Samsung Medical Center, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahesh K.","family":"Goenka","sequence":"additional","affiliation":[{"name":"Apollo Gleneagles Hospital, Kolkata, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randhir","family":"Sud","sequence":"additional","affiliation":[{"name":"Medanta the Medicity, Gurgaon, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nam Q.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Royal Adelaide Hospital, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakesh","family":"Kochhar","sequence":"additional","affiliation":[{"name":"Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce","family":"Peetermans","sequence":"additional","affiliation":[{"name":"Boston Scientific Corporation, Marlborough, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pooja G.","family":"Goswamy","sequence":"additional","affiliation":[{"name":"Boston Scientific Corporation, Marlborough, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Rousseau","sequence":"additional","affiliation":[{"name":"Boston Scientific Corporation, Marlborough, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surya Prakash","family":"Bhandari","sequence":"additional","affiliation":[{"name":"Baldota Institute of Digestive Sciences, Global Hospital, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phonthep","family":"Angsuwatcharakon","sequence":"additional","affiliation":[{"name":"Chulalongkorn University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond S. Y.","family":"Tang","sequence":"additional","affiliation":[{"name":"Prince of Wales Hospital, Shatin, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony Y. B.","family":"Teoh","sequence":"additional","affiliation":[{"name":"Prince of Wales Hospital, Shatin, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majid","family":"Almadi","sequence":"additional","affiliation":[{"name":"King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun Nah","family":"Lee","sequence":"additional","affiliation":[{"name":"SoonChunHyang University Hospital, Bucheon, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong Ho","family":"Moon","sequence":"additional","affiliation":[{"name":"SoonChunHyang University Hospital, Bucheon, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the SpyGlass AMEA Registry Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2019,6,27]]},"container-title":["Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-0942-9336.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,9,26]],"date-time":"2019-09-26T23:01:43Z","timestamp":1569538903000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-0942-9336"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,27]]},"references-count":0,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2019,9,26]]},"published-print":{"date-parts":[[2019,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-0942-9336","relation":{},"ISSN":["0013-726X","1438-8812"],"issn-type":[{"value":"0013-726X","type":"print"},{"value":"1438-8812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,27]]}}}