Single-Operator Cholangioscopy-Guided Electrohydraulic Lithotripsy for Difficult Common Bile Duct Stones: A Prospective Cohort Study of Efficacy, Safety, and Clinical Outcomes
15 affiliations
- 1Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- 2Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- 3Department of Anesthesia, ICU and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- 4Department of Hepatology, Gastroenterology and Infectious Diseases, Ahmed Maher Teaching Hospital, Cairo, Egypt
- 5Department of Internal Medicine, Gastroenterology and Hepatology Unit, Faculty of Medicine, Tanta University, Tanta, Egypt
- 6Department of Geriatrics and Gerontology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- 7Department of Internal Medicine, Faculty of Medicine, Benha University, Benha, Egypt
- 8Department of Biochemistry, King Abdulaziz University, Jeddah, Saudi Arabia
- 9Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- 10Department of Tropical Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- 11Department of Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
- 12Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt
- 13Department of Medicine, College of Medicine, Qassim University, Saudi Arabia
- 14Department of Medicine, Division of Gastroenterology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- 15Department of Internal Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
Abstract
Background: Difficult common bile duct (CBD) stones, characterized by a diameter exceeding 15 mm, impaction, multiple stone burden, or associated biliary strictures, constitute 10–15% of endoscopic retrograde cholangiopancreatography (ERCP) cases and often resist conventional extraction. The application of single-operator cholangioscopy (SOC)–based electrohydraulic lithotripsy (EHL) has shown positive results as an advanced treatment method, although its real-world effectiveness needs further exploration in settings that lack resources. The researchers conducted a prospective study to assess the safety and effectiveness of SOC-based EHL treatment for patients with difficult CBD stones who did not respond to standard ERCP methods.
Methods: The researchers conducted a prospective single-arm cohort study at Al-Azhar University Hospitals, which started in November 2023 and ended in July 2024 after they enrolled 25 consecutive patients who had failed standard extraction methods for difficult CBD stone removal. The patients received SOC-guided EHL treatment through the SpyGlass system, which enabled them to retrieve stone fragments using either balloon sweepers or Dormia baskets. The primary outcome tracked complete stone clearance through occlusion cholangiography, while the secondary outcomes measured three different factors, which included procedural success, assessment of ERCP sessions, and complication rates.
Results: The study enrolled 25 patients who consisted of 14 females and 11 males with an average age of 61.8 years and a standard deviation of 6.4 years. The study found that the mean largest stone diameter measured 15.6 mm with a standard deviation of 3.3 mm, while 14 patients (56.0%) had multiple stones and 15 patients (60.0%) had stones that exceeded 15 mm in size. The study achieved complete ductal clearance for 22 patients (88.0%) while performing balloon extraction in 22 cases (88.0%) and using controlled radial expansion balloon dilation as an adjunct in five cases (20.0%). The study found no major complications, which included post-ERCP pancreatitis, bleeding, and perforation.
Conclusion: The SOC-guided EHL system achieves high success rates through 88.0% stone elimination while maintaining a safe operational record, which enables its use as a primary treatment method for complex endoscopic procedures that decrease the need for surgical or percutaneous methods.
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BibTeX
@article{ghoname2026singleoperator,
title = {{Single-Operator Cholangioscopy-Guided Electrohydraulic Lithotripsy for Difficult Common Bile Duct Stones: A Prospective Cohort Study of Efficacy, Safety, and Clinical Outcomes}},
author = {Mahmod Ghoname and Mohammad Abd Elhameed Alwaseef and Ahmed Shaaban and Sherif Mohamed Elsayed Amin Hegab and Ahmed Fawzy Selim and Mohammed Zain Abdelwadoud and Tayseer S. Karoof and Noha Fawzi Alrowaithy and Sayed Ahmed Sayed and Ashraf Ahmed Mohamed Aboismail and Yasser Rabie Abdulaziz Taalab and Housam Ahmad Helmy and Abdulmajeed Albarrak and Saad S. Alkhowaiter and Mohamed Galal Flefel},
journal = {Journal of Clinical Medicine Research},
year = {2026},
month = oct,
doi = {10.14740/jocmr6650},
url = {https://europepmc.org/article/PMC/PMC13719650},
note = {CC BY},
}
RIS
TY - JOUR
TI - Single-Operator Cholangioscopy-Guided Electrohydraulic Lithotripsy for Difficult Common Bile Duct Stones: A Prospective Cohort Study of Efficacy, Safety, and Clinical Outcomes
AU - Mahmod Ghoname
AU - Mohammad Abd Elhameed Alwaseef
AU - Ahmed Shaaban
AU - Sherif Mohamed Elsayed Amin Hegab
AU - Ahmed Fawzy Selim
AU - Mohammed Zain Abdelwadoud
AU - Tayseer S. Karoof
AU - Noha Fawzi Alrowaithy
AU - Sayed Ahmed Sayed
AU - Ashraf Ahmed Mohamed Aboismail
AU - Yasser Rabie Abdulaziz Taalab
AU - Housam Ahmad Helmy
AU - Abdulmajeed Albarrak
AU - Saad S. Alkhowaiter
AU - Mohamed Galal Flefel
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine Research
DO - 10.14740/jocmr6650
UR - https://europepmc.org/article/PMC/PMC13719650
AB - Background: Difficult common bile duct (CBD) stones, characterized by a diameter exceeding 15 mm, impaction, multiple stone burden, or associated biliary strictures, constitute 10–15% of endoscopic retrograde cholangiopancreatography (ERCP) cases and often resist conventional extraction. The application of single-operator cholangioscopy (SOC)–based electrohydraulic lithotripsy (EHL) has shown positive results as an advanced treatment method, although its real-world effectiveness needs further exploration in settings that lack resources. The researchers conducted a prospective study to assess the safety and effectiveness of SOC-based EHL treatment for patients with difficult CBD stones who did not respond to standard ERCP methods. Methods: The researchers conducted a prospective single-arm cohort study at Al-Azhar University Hospitals, which started in November 2023 and ended in July 2024 after they enrolled 25 consecutive patients who had failed standard extraction methods for difficult CBD stone removal. The patients received SOC-guided EHL treatment through the SpyGlass system, which enabled them to retrieve stone fragments using either balloon sweepers or Dormia baskets. The primary outcome tracked complete stone clearance through occlusion cholangiography, while the secondary outcomes measured three different factors, which included procedural success, assessment of ERCP sessions, and complication rates. Results: The study enrolled 25 patients who consisted of 14 females and 11 males with an average age of 61.8 years and a standard deviation of 6.4 years. The study found that the mean largest stone diameter measured 15.6 mm with a standard deviation of 3.3 mm, while 14 patients (56.0%) had multiple stones and 15 patients (60.0%) had stones that exceeded 15 mm in size. The study achieved complete ductal clearance for 22 patients (88.0%) while performing balloon extraction in 22 cases (88.0%) and using controlled radial expansion balloon dilation as an adjunct in five cases (20.0%). The study found no major complications, which included post-ERCP pancreatitis, bleeding, and perforation. Conclusion: The SOC-guided EHL system achieves high success rates through 88.0% stone elimination while maintaining a safe operational record, which enables its use as a primary treatment method for complex endoscopic procedures that decrease the need for surgical or percutaneous methods.
SN - 1918-3003
SN - 1918-3011
ER -