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SpyGlass-guided laser lithotripsy versus laparoscopic common bile duct exploration for large common bile duct stones: a non-inferiority trial

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Abstract

Background

Laparoscopic common bile duct exploration (LCBDE) is the first choice of treatment for large common bile duct (CBD) stones. Recently, single-operator cholangioscopy (SpyGlass system) has been introduced widely in referral and large medical centers. Several studies have reported favorable results for treatment of large CBD stones guided by SpyGlass. We evaluated the clinical efficacy and safety of SpyGlass-guided laser lithotripsy LCBDE for treatment of large CBD stones.

Methods

From August 2015 to August 2018, 157 patients with large bile duct stones who met the inclusion criteria were randomly divided into two groups: SpyGlass-guided laser lithotripsy (Group A) and LCBDE (Group B). The efficacy and complications were compared between the groups.

Results

Although the first-session stone removal rate in Group A was significantly lower than that in Group B, Group A was not inferior to Group B in terms of total stone removal rate. Compared with Group B, Group A had shorter hospital stay and enhanced recovery. The short-term complication rates were also similar between the two groups.

Conclusions

The clinical efficacy of SpyGlass-guided laser lithotripsy for the treatment of large CBD stones is not inferior to that of LCBDE, and it is less invasive. SpyGlass-guided laser lithotripsy is an important option for treatment of large CBD stones.

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Acknowledgements

This trial was conceived by the first and last authors. All the authors had substantial roles in the design of the study, data interpretation, and writing of the manuscript. All authors have access to the study data and reviewed and approved the final manuscript.

Funding

This research was supported by a Grant: Jinan healthcare science and technology plan (201602174).

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Authors and Affiliations

  1. Department of Endoscopy, the First Affiliated Hospital of Shandong First Medical, University, 250014, Jinan, China

    Guodong Li, Qiuping Pang, Hailan Zhai, Xiujuan Zhang, Yanchun Dong & Xinyong Jia

  2. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Shandong First Medical University, 250014, Jinan, China

    Ji Li

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  1. Guodong Li
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  2. Qiuping Pang
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  3. Hailan Zhai
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  6. Ji Li
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  7. Xinyong Jia
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Corresponding authors

Correspondence to Qiuping Pang or Xinyong Jia.

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Disclosures

Guodong L, Qiuping Pang, Hailan Zhai, Xiujuan Zhang, Yanchun Dong, Ji Li, Xinyong Jia have no conflict of interest or financial ties to disclose.

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Li, G., Pang, Q., Zhai, H. et al. SpyGlass-guided laser lithotripsy versus laparoscopic common bile duct exploration for large common bile duct stones: a non-inferiority trial. Surg Endosc 35, 3723–3731 (2021). https://doi.org/10.1007/s00464-020-07862-4

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  • DOI: https://doi.org/10.1007/s00464-020-07862-4

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