{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T10:10:50Z","timestamp":1791972650537,"version":"4.3.4"},"reference-count":14,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T00:00:00Z","timestamp":1702252800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Approach to management of common bile duct stones (CBDS) by endoscopic retrograde cholangiopancreatography (ERCP) is not standardized. We examined outcomes by applying predetermined protocol for CBDS management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>When standard extraction techniques failed at ERCP, presence of tapered bile duct and stone\u2013duct ratio were calculated. Large balloon sphincteroplasty (LBS) and\/or mechanical\/single\u2010operator cholangioscopy\u2010guided lithotripsy was performed based on presence of tapered bile duct and stone\u2013duct mismatch. Primary outcome was single\u2010session ductal clearance. Secondary outcome was adverse events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 409 patients treated over 16\u2009months, 321 (78.5%) had no tapered bile duct or stone\u2013duct mismatch, and single\u2010session ductal clearance was achieved using standard techniques in 99.7% over median duration of 14\u2009min (interquartile range [IQR] 9\u201321\u2009min). Of 88 (21.5%) patients with difficult CBDS, tapered duct was seen in 79 (89.8%) and\/or stone\u2013duct mismatch in 36 (40.9%). Single\u2010session ductal clearance was achieved in all 88 patients (100%) by LBS in 79 (89.8%), mechanical lithotripsy in 20 (22.7%), and single\u2010operator cholangioscopy\u2010guided lithotripsy in 16 (18.2%) over a median duration of 29\u2009min (IQR 17\u201347\u2009min). Overall, single\u2010session ductal clearance was achieved in 99.8% with adverse events in 17 (4.2%) that included perforation in two, postsphincterotomy bleeding in one, and mild\/moderate post\u2010ERCP pancreatitis in 14 patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A predetermined protocol optimized outcomes by enabling single\u2010session ductal clearance of CBDS with high technical success and low adverse events.<\/jats:p><\/jats:sec>","DOI":"10.1111\/den.14719","type":"journal-article","created":{"date-parts":[[2023,11,13]],"date-time":"2023-11-13T05:56:40Z","timestamp":1699855000000},"page":"825-833","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Orlando Protocol for single session ductal clearance of common bile duct stones at endosopic retrograde cholangiopancreatography"],"prefix":"10.1111","volume":"36","author":[{"given":"Ji Young","family":"Bang","sequence":"first","affiliation":[{"name":"Digestive Health Institute, Orlando Health  Orlando FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Mel","family":"Wilcox","sequence":"additional","affiliation":[{"name":"Digestive Health Institute, Orlando Health  Orlando FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Udayakumar","family":"Navaneethan","sequence":"additional","affiliation":[{"name":"Digestive Health Institute, Orlando Health  Orlando FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Hawes","sequence":"additional","affiliation":[{"name":"Digestive Health Institute, Orlando Health  Orlando FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shyam","family":"Varadarajulu","sequence":"additional","affiliation":[{"name":"Digestive Health Institute, Orlando Health  Orlando FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,12,11]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11938-006-0031-6"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2018.10.001"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-0862-0346"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.giec.2012.05.007"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2017.08.021"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2014.76"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2005.05.016"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.02.003"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2009.10.027"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1047"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2012.02.019"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(04)00295-0"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1499-3872(11)60068-4"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000001690"}],"container-title":["Digestive Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/den.14719","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T04:46:51Z","timestamp":1720759611000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/den.14719"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,11]]},"references-count":14,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2024,7]]}},"alternative-id":["10.1111\/den.14719"],"URL":"https:\/\/doi.org\/10.1111\/den.14719","archive":["Portico"],"relation":{},"ISSN":["0915-5635","1443-1661"],"issn-type":[{"value":"0915-5635","type":"print"},{"value":"1443-1661","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,11]]},"assertion":[{"value":"2023-08-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-05","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-12-11","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}