Novel peroral cholangioscopy-directed lithotripsy using an ultraslim upper endoscope for refractory Mirizzi syndrome: A case report.

Abstract:

RATIONALE:Mirizzi syndrome (MS) is an uncommon condition characterized by common hepatic duct (CHD) compression by an impacted gallbladder or cystic duct stones or adjacent inflammation. To date, a standardized therapeutic strategy for MS has not been established yet, owing to its complex clinical presentation. Thus, researchers still have to develop new optimized approaches to solve this problem. Herein, we describe a patient with refractory MS who underwent a successful treatment by novel hybrid anchoring balloon-guided direct peroral cholangioscopy (POC) using an ultraslim endoscope. PATIENT CONCERNS:A 56-year-old man with a history of biliary stone was referred to our hospital for complaints of discomfort in the right upper quadrant of the abdomen and obstructive jaundice. Endoscopic retrograde cholangiopancreatography showed an 18-mm impacted stone at the level of the cystic duct, which compressed the CHD. The CHD had local stricture, with its upstream and intrahepatic bile duct dilation. DIAGNOSES:He was diagnosed with type I MS. INTERVENTIONS:Initially, the patient received an endoscopic major sphincterotomy. However, conventional stone extraction, including mechanical lithotripsy, was unsuccessful. Then, after signing the informed consent form for further treatment, he was successfully treated with novel hybrid anchoring balloon-guided direct POC. OUTCOMES:The patient had no operative complications and was discharged with cleared ducts. At the 3-year follow-up, he was asymptomatic. LESSONS:Our novel hybrid anchoring balloon-guided direct POC may be an effective alternative treatment approach for difficult gallbladder cases, such as refractory MS.

journal_name

Medicine (Baltimore)

journal_title

Medicine

authors

Li J,Guo SJ,Zhang JC,Wang HY,Li K,Xu CS,Wang XF

doi

10.1097/MD.0000000000022649

subject

Has Abstract

pub_date

2020-11-06 00:00:00

pages

e22649

issue

45

eissn

0025-7974

issn

1536-5964

pii

00005792-202011060-00014

journal_volume

99

pub_type

杂志文章

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