{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T18:51:37Z","timestamp":1793386297903,"version":"4.5.0"},"reference-count":32,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Background\u2002Peroral cholangioscopy with intraductal lithotripsy facilitates optically guided stone fragmentation of difficult biliary stones refractory to conventional endoscopic therapy. The aim of this study was to evaluate the efficacy and safety of peroral cholangioscopy with intraductal lithotripsy for difficult biliary stones.<\/jats:p>\n                  <jats:p>Methods\u2002Searches of PubMed, EMBASE, Web of Science, and Cochrane databases were performed in accordance with PRISMA and MOOSE guidelines. Measured outcomes included overall fragmentation success, single-session fragmentation and duct clearance, and rate of adverse events. Sensitivity and subgroup analyses were performed based upon cholangioscopy technique and type of lithotripsy (laser versus electrohydraulic). Heterogeneity was assessed with I\n          2 statistics. Publication bias was ascertained by funnel plot and Egger regression testing.<\/jats:p>\n                  <jats:p>Results\u200235 studies were included with 1762 participants (43.4\u200a% men; mean age 61.5 [standard deviation (SD) 11.0]). Prior cholecystectomy had been performed in 37\u200a% of patients, with a mean number of 1.6 (SD 0.5) ERCPs performed prior to lithotripsy. Mean stone size was 1.8 (SD 0.3) cm. Peroral cholangioscopy with intraductal lithotripsy achieved an overall stone fragmentation success of 91.2\u200a% (95\u200a%CI 88.1\u200a%\u200a\u2013\u200a93.6\u200a%; I\n          2\u200a=\u200a63.2\u200a%) with an average of 1.3 [SD 0.6] lithotripsy sessions performed. Complete single-session fragmentation success was 76.9\u200a% (95\u200a%CI 71.6\u200a%\u200a\u2013\u200a81.4\u200a%; I\n          2\u200a=\u200a74.3\u200a%). The adverse events rate was 8.9\u200a% (95\u200a%CI 6.5\u200a%\u200a\u2013\u200a12.2\u200a%; I\n          2\u200a=\u200a60.6\u200a%). Mean procedure time for peroral cholangioscopy was 67.1 (SD 21.4) minutes. There was no difference in overall fragmentation rate or adverse events; however, laser lithotripsy was associated with a higher single-session fragmentation rate and shorter procedure time compared with electrohydraulic lithotripsy.<\/jats:p>\n                  <jats:p>Conclusions\u2002Peroral cholangioscopy with intraductal lithotripsy appears to be a relatively safe and effective modality for difficult biliary stones.<\/jats:p>","DOI":"10.1055\/a-1200-8064","type":"journal-article","created":{"date-parts":[[2020,6,16]],"date-time":"2020-06-16T19:49:15Z","timestamp":1592336955000},"page":"110-122","source":"Crossref","is-referenced-by-count":44,"title":["Efficacy and safety of peroral cholangioscopy with intraductal lithotripsy for difficult biliary stones: a systematic review and meta-analysis"],"prefix":"10.1055","volume":"53","author":[{"given":"Thomas R.","family":"McCarty","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rishabh","family":"Gulati","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, New Mexico, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarun","family":"Rustagi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, New Mexico, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,10,5]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"S165","DOI":"10.1016\/S0016-5107(02)70005-9","article-title":"Epidemiology and natural history of common bile duct stones and prediction of disease","volume":"56","author":"C W Ko","year":"2002","journal-title":"Gastrointest Endosc"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1001\/jamasurg.2014.249","article-title":"Natural course vs interventions to clear common bile duct stones: data from the Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks)","volume":"149","author":"M Moller","year":"2014","journal-title":"JAMA Surg"},{"key":"ref3","first-page":"220","article-title":"Does selective peroperative cholangiography result in missed common bile duct stones?","volume":"38","author":"M S Murison","year":"1993","journal-title":"J R Coll Surg Edinb"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/bjs.1800670102","article-title":"Non-operative removal of bile duct stones by duodenoscopic sphincterotomy","volume":"67","author":"P B Cotton","year":"1980","journal-title":"Br J Surg"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"165","DOI":"10.3748\/wjg.v19.i2.165","article-title":"Endoscopic management of difficult common bile duct stones","volume":"19","author":"G Trikudanathan","year":"2013","journal-title":"World J Gastroenterol"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"1766","DOI":"10.1002\/bjs.7690","article-title":"Nationwide study of the treatment of common bile duct stones in Sweden between 1965 and 2009","volume":"98","author":"C Stromberg","year":"2011","journal-title":"Br J Surg"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1055\/a-0862-0346","article-title":"Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline","volume":"51","author":"G Manes","year":"2019","journal-title":"Endoscopy"},{"key":"ref8","first-page":"241","article-title":"Peroral cholangiopancreatosocopy (PCPS) under duodenoscopic guidance","volume":"66","author":"M Nakajima","year":"1976","journal-title":"Am J Gastroenterol"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1055\/s-0028-1098481","article-title":"Peroral direct cholangioscopy (PDCS) using routine straight-view endoscope: first report","volume":"9","author":"Y Urakami","year":"1977","journal-title":"Endoscopy"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1016\/j.gie.2007.04.033","article-title":"Factors influencing the technical difficulty of endoscopic clearance of bile duct stones","volume":"66","author":"H J Kim","year":"2007","journal-title":"Gastrointest Endosc"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"W65","DOI":"10.7326\/0003-4819-151-4-200908180-00136","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration","volume":"151","author":"A Liberati","year":"2009","journal-title":"Ann Int Med"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1001\/jama.283.15.2008","article-title":"Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group","volume":"283","author":"D F Stroup","year":"2000","journal-title":"JAMA"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/0197-2456(86)90046-2","article-title":"Meta-analysis in clinical trials","volume":"7","author":"R DerSimonian","year":"1986","journal-title":"Controlled Clin Trials"},{"key":"ref14","volume-title":"Kendall\u2019s Advanced Theory of Statistics. 6th edn","author":"A Stuart","year":"1994"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"d549","DOI":"10.1136\/bmj.d549","article-title":"Interpretation of random effects meta-analyses","volume":"342","author":"R D Riley","year":"2011","journal-title":"BMJ"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"J P Higgins","year":"2003","journal-title":"BMJ"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1037\/1082-989X.3.3.354","article-title":"A comparison of fixed-effects and mixed (random-effects) models for meta-analysis tests of moderator variable effects","volume":"3","author":"R C Overton","year":"1998","journal-title":"Psychol Methods"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1002\/jrsm.1230","article-title":"Basics of meta-analysis: I(2) is not an absolute measure of heterogeneity","volume":"8","author":"M Borenstein","year":"2017","journal-title":"Res Synth Methods"},{"key":"ref21","volume-title":"Introduction to meta-analysis","author":"M Borenstein","year":"2011"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"M Egger","year":"1997","journal-title":"BMJ"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1016\/0140-6736(91)90201-Y","article-title":"Publication bias in clinical research","volume":"337","author":"P J Easterbrook","year":"1991","journal-title":"Lancet"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1111\/j.0006-341X.2000.00455.x","article-title":"Trim and fill: a simple funnel-plot\u2013based method of testing and adjusting for publication bias in metaanalysis","volume":"56","author":"S Duval","year":"2000","journal-title":"Biometrics"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"31","DOI":"10.4253\/wjge.v11.i1.31","article-title":"Role of digital single-operator cholangioscopy in the diagnosis and treatment of biliary disorders","volume":"11","author":"P Karagyozov","year":"2019","journal-title":"World J Gastrointest Endosc"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"4722","DOI":"10.3748\/wjg.v21.i15.4722","article-title":"Per oral cholangiopancreatoscopy in pancreatico biliary diseases--expert consensus statements","volume":"21","author":"M Ramchandani","year":"2015","journal-title":"World J Gastroenterol"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1111\/j.1572-0241.2006.00383.x","article-title":"Is there a role for cholangioscopy in patients with primary sclerosing cholangitis?","volume":"101","author":"N S Awadallah","year":"2006","journal-title":"Am J Gastroenterol"},{"key":"ref28","first-page":"119","article-title":"Recent developments in choledochoscopy: technical and clinical advances","volume":"9","author":"M M Xu","year":"2016","journal-title":"Clin Exp Gastroenterol"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4253\/wjge.v6.i1.1","article-title":"Direct peroral cholangioscopy","volume":"6","author":"M A Parsi","year":"2014","journal-title":"World J Gastrointest Endosc"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.gie.2016.03.013","article-title":"Cholangiopancreatoscopy","volume":"84","author":"S Komanduri","year":"2016","journal-title":"Gastrointest Endosc"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/S0016-5107(87)71566-1","article-title":"Evaluation of electrohydraulic lithotripsy as a means of gallstone fragmentation in a canine model","volume":"33","author":"C E Sievert Jr.","year":"1987","journal-title":"Gastrointest Endosc"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1016\/0016-5085(91)90093-Z","article-title":"Lithotripsy of gallstones by means of a quality-switched giant-pulse neodymium: yttrium-aluminum-garnet laser. Basic in vitro studies using a highly flexible fiber system","volume":"101","author":"J Hochberger","year":"1991","journal-title":"Gastroenterology"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"E263","DOI":"10.1055\/s-0042-100194","article-title":"The efficacy of peroral cholangioscopy for difficult bile duct stones and indeterminate strictures: a systematic review and meta-analysis","volume":"4","author":"P Korrapati","year":"2016","journal-title":"Endosc Int Open"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1055\/a-0637-8806","article-title":"A systematic review of advanced endoscopy-assisted lithotripsy for retained biliary tract stones: laser, electrohydraulic or extracorporeal shock wave","volume":"50","author":"J V Veld","year":"2018","journal-title":"Endoscopy"}],"container-title":["Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1200-8064.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T05:43:36Z","timestamp":1660110216000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1200-8064"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,16]]},"references-count":32,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2021,1,27]]},"published-print":{"date-parts":[[2021,2]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1200-8064","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0013-726X","1438-8812"],"issn-type":[{"value":"0013-726X","type":"print"},{"value":"1438-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,6,16]]},"published":{"date-parts":[[2020,6,16]]}}}