Top

Digestive Diseases and Sciences

Published in:

29-01-2022 | Pancreatitis | Original Article

Comparison of Different Endoscopic Methods Used for Managing Choledocholithiasis in Patients with End-Stage Renal Disease Undergoing Hemodialysis

Authors: Jhong-Han Wu, Jui-Wen Kang, Yao-Sheng Wang, Hsiao-Ju Lin, Chiung-Yu Chen

Published in: Digestive Diseases and Sciences | Issue 11/2022

Abstract

Background and Aim

Endoscopic sphincterotomy (EST), endoscopic papillary balloon dilation (EPBD), and endoscopic sphincterotomy plus balloon dilation (ESBD) are all techniques used to manage choledocholithiasis. We aim to analyze the efficacy and safety of these techniques for treating choledocholithiasis in patients undergoing hemodialysis (HD).

Methods

We performed a retrospective study of 80 patients with end-stage renal disease (ESRD) on HD who underwent endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis management between August 1st, 2012, and December 31st, 2020, at a medical center in southern Taiwan. These patients were divided into three groups: EST (n = 21), EPBD (n = 28), and ESBD (n = 31). Post-ERCP complications, including pancreatitis, bleeding, cholangitis, and perforation, were reviewed for analysis.

Results

There were no significant among-group differences in the rate of complete stone clearance and hospitalization day after ERCP. Patients in the EST group had a higher post-ERCP complication rate than was the case in the other groups (p = 0.016). ESBD significantly reduced post-ERCP bleeding, compared with that occurring with EST (OR 0.07; 95% CI, 0.01–0.72, p = 0.026). There were no significant among-group differences in the rates of pancreatitis and cholangitis. There were no ERCP-related perforations or deaths in this study.

Conclusions

EST, EPBD, and ESBD are efficient methods for treating choledocholithiasis in ESRD patients. ESBD was found to lead to a lower risk of bleeding than EST, and the rate of pancreatitis or cholangitis was comparable for EST and EPBD. Our results suggest that ESBD is the best choice of treatment of choledocholithiasis in patients with ESRD undergoing HD.

Tsai MH, Hsu CY, Lin MY et al. Incidence, prevalence, and duration of chronic kidney disease in Taiwan: results from a community-based screening program of 106,094 individuals. Nephron. 2018;140:175–184.PubMedCrossRef

Hahm JS, Lee HL, Park JY et al. Prevalence of gallstone disease in patients with end-stage renal disease treated with hemodialysis in Korea. Hepato-Gastroenterol. 2003;50:1792–1795.

Classen M, Demling L. Endoscopic sphincterotomy of the papilla of vater and extraction of stones from the choledochal duct (author’s transl). Deutsche Medizinische Wochenschrift 1946;1974:496–497.

Nakajima M, Kimoto K, Fukumoto K et al. Endoscopic sphincterotomy of the ampulla of Vater and removal of common duct stones. Am J Gastroenterol. 1975;64:34–43.PubMed

Zimmon DS, Falkenstein DB, Kessler RE. Endoscopic papillotomy for choledocholithiasis. N Engl J Med. 1975;293:1181–1182.PubMedCrossRef

Staritz M, Ewe K, Zum Buschenfelde KHM. Endoscopic papillary dilatation, a possible alternative to endoscopic papillotomy. Lancet (Lond Engl) 1982;1:1306–1307.CrossRef

Staritz M, Ewe K, Zum Buschenfelde KHM. Endoscopic papillary dilation (EPD) for the treatment of common bile duct stones and papillary stenosis. Endoscopy. 1983;15:197–198.PubMedCrossRef

Baron TH, Harewood GC. Endoscopic balloon dilation of the biliary sphincter compared to endoscopic biliary sphincterotomy for removal of common bile duct stones during ERCP: a metaanalysis of randomized, controlled trials. Am J Gastroenterol. 2004;99:1455–1460.PubMedCrossRef

Kogure H, Kawahata S, Mukai T et al. Multicenter randomized trial of endoscopic papillary large balloon dilation without sphincterotomy versus endoscopic sphincterotomy for removal of bile duct stones: MARVELOUS trial. Endoscopy. 2020;52:736–744.PubMedCrossRef

10.

Li T, Wen J, Bie L et al. Comparison of the long-term outcomes of endoscopic papillary large balloon dilation alone versus endoscopic sphincterotomy for removal of bile duct stones. Gastroenterol Res Pract. 2018;2018:6430701.PubMedPubMedCentralCrossRef

11.

Disario JA, Freeman ML, Bjorkman DJ et al. Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. Gastroenterology. 2004;127:1291–1299.PubMedCrossRef

12.

Liu Y, Su P, Lin S et al. Endoscopic papillary balloon dilatation versus endoscopic sphincterotomy in the treatment for choledocholithiasis: a meta-analysis. J Gastroenterol Hepatol. 2012;27:464–471.PubMedCrossRef

13.

Lu Y, Wu JC, Liu L et al. Short-term and long-term outcomes after endoscopic sphincterotomy versus endoscopic papillary balloon dilation for bile duct stones. Eur J Gastroenterol Hepatol. 2014;26:1367–1373.PubMedCrossRef

14.

Ersoz G, Tekesin O, Ozutemiz AO et al. Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract. Gastrointest Endosc. 2003;57:156–159.PubMedCrossRef

15.

Park CH, Jung JH, Nam E et al. Comparative efficacy of various endoscopic techniques for the treatment of common bile duct stones: a network meta-analysis. Gastrointest Endosc. 2018;87:43-57.e10.PubMedCrossRef

16.

Kim TH, Oh HJ, Lee JY et al. Can a small endoscopic sphincterotomy plus a large-balloon dilation reduce the use of mechanical lithotripsy in patients with large bile duct stones? Surg Endosc. 2011;25:3330–3337.PubMedCrossRef

17.

Hori Y, Naitoh I, Nakazawa T et al. Feasibility of endoscopic retrograde cholangiopancreatography-related procedures in hemodialysis patients. J Gastroenterol Hepatol. 2014;29:648–652.PubMedCrossRef

18.

Sawas T, Bazerbachi F, Haffar S et al. End-stage renal disease is associated with increased post endoscopic retrograde cholangiopancreatography adverse events in hospitalized patients. World J Gastroenterol. 2018;24:4691–4697.PubMedPubMedCentralCrossRef

19.

Tsai MC, Wang CC, Wang YT et al. Major bleeding risk of endoscopic sphincterotomy versus endoscopic papillary balloon dilatation in hemodialysis patients. Saudi J Gastroenterol Off J Saudi Gastroenterol Assoc. 2019;25:106–112.CrossRef

20.

Fujimoto K, Fujishiro M, Kato M et al. Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. Dig Endosc. 2014;26:1–14.PubMedCrossRef

21.

Veitch AM, Vanbiervliet G, Gershlick AH et al. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Gut. 2016;65:374–389.PubMedCrossRef

22.

Veitch AM, Radaelli F, Alikhan R et al. Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update. Gut. 2021;70:1611–1628.PubMedCrossRef

23.

Janson PA, Jubelirer SJ, Weinstein MJ et al. Treatment of the bleeding tendency in uremia with cryoprecipitate. N Engl J Med. 1980;303:1318–1322.PubMedCrossRef

24.

Mannucci PM, Remuzzi G, Pusineri F et al. Deamino-8-D-arginine vasopressin shortens the bleeding time in uremia. N Engl J Med. 1983;308:8–12.PubMedCrossRef

25.

Elmunzer BJ, Scheiman JM, Lehman GA et al. A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. N Engl J Med. 2012;366:1414–1422.PubMedPubMedCentralCrossRef

26.

Hou YC, Hu Q, Huang J et al. Efficacy and safety of rectal nonsteroidal anti-inflammatory drugs for prophylaxis against post-ERCP pancreatitis: a systematic review and meta-analysis. Sci Rep. 2017;7:46650.PubMedPubMedCentralCrossRef

27.

Dumonceau JM, Kapral C, Aabakken L et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2020;52:127–149.PubMedCrossRef

28.

Liao WC, Lee CT, Chang CY et al. Randomized trial of 1-minute versus 5-minute endoscopic balloon dilation for extraction of bile duct stones. Gastrointest Endosc. 2010;72:1154–1162.PubMedCrossRef

29.

Cotton PB, Lehman G, Vennes J et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37:383–393.PubMedCrossRef

30.

Kim SB, Kim KH, Kim TN. Safety and efficacy of endoscopic retrograde cholangiopancreatography for choledocholithiasis in long-term dialysis: a propensity score analysis. Dig Dis Sci. 2018;63:3141–3146.PubMedCrossRef

31.

Nakaji S, Hirata N, Matsui H et al. Hemodialysis is a strong risk factor for post-endoscopic sphincterotomy bleeding in patients with choledocholithiasis. Endosc Int Open. 2018;6:E568–E574.PubMedPubMedCentralCrossRef

32.

Park JS, Jeong S, Cho JH et al. Clinical outcome of endoscopic retrograde cholangiopancreatography for choledocholithiasis in end-stage renal disease patients on hemodialysis. Turk J Gastroenterol. 2020;31:538–546.PubMedPubMedCentralCrossRef

33.

Boccardo P, Remuzzi G, Galbusera M. Platelet dysfunction in renal failure. Semin Thromb Hemost. 2004;30:579–589.PubMedCrossRef

34.

Cotton PB, Eisen GM, Aabakken L et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71:446–454.PubMedCrossRef

35.

Hedges SJ, Dehoney SB, Hooper JS et al. Evidence-based treatment recommendations for uremic bleeding. Nat Clin Pract Nephrol. 2007;3:138–153.PubMedCrossRef

36.

Acosta RD, Abraham NS, Chandrasekhara V et al. The management of antithrombotic agents for patients undergoing GI endoscopy. Gastrointest Endosc. 2016;83:3–16.PubMedCrossRef

37.

Chan FKL, Goh KL, Reddy N et al. Management of patients on antithrombotic agents undergoing emergency and elective endoscopy: joint Asian Pacific Association of Gastroenterology (APAGE) and Asian Pacific Society for Digestive Endoscopy (APSDE) practice guidelines. Gut. 2018;67:405–417.PubMedCrossRef

38.

Patrono C, García Rodríguez LA, Landolfi R et al. Low-dose aspirin for the prevention of atherothrombosis. N Engl J Med. 2005;353:2373–2383.PubMedCrossRef

39.

Ding J, Li F, Zhu HY et al. Endoscopic treatment of difficult extrahepatic bile duct stones, EPBD or EST: AN anatomic view. World J Gastrointestinal Endosc. 2015;7:274–277.CrossRef

40.

Karsenti D, Coron E, Vanbiervliet G et al. Complete endoscopic sphincterotomy with vs. without large-balloon dilation for the removal of large bile duct stones: randomized multicenter study. Endoscopy. 2017;49:968–976.PubMedCrossRef

41.

Dong SQ, Singh TP, Zhao Q et al. Sphincterotomy plus balloon dilation versus sphincterotomy alone for choledocholithiasis: a meta-analysis. Endoscopy. 2019;51:763–771.PubMedCrossRef

42.

Ishii S, Fujisawa T, Ushio M, et al. Evaluation of the safety and efficacy of minimal endoscopic sphincterotomy followed by papillary balloon dilation for the removal of common bile duct stones. Saudi journal of gastroenterology: official journal of the Saudi Gastroenterology Association. 2020.

43.

Park SJ, Kim JH, Hwang JC et al. Factors predictive of adverse events following endoscopic papillary large balloon dilation: results from a multicenter series. Dig Dis Sci. 2013;58:1100–1109.PubMedCrossRef

44.

Meng W, Leung JW, Zhang K et al. Optimal dilation time for combined small endoscopic sphincterotomy and balloon dilation for common bile duct stones: a multicentre, single-blinded, randomised controlled trial. Lancet Gastroenterol Hepatol. 2019;4:425–434.PubMedCrossRef

Title: Comparison of Different Endoscopic Methods Used for Managing Choledocholithiasis in Patients with End-Stage Renal Disease Undergoing Hemodialysis
Authors: Jhong-Han Wu
Jui-Wen Kang
Yao-Sheng Wang
Hsiao-Ju Lin
Chiung-Yu Chen
Publication date: 29-01-2022
Publisher: Springer US
Keywords: Pancreatitis
Endoscopic Retrograde Cholangiopancreatography
Choledocholithiasis
Published in: Digestive Diseases and Sciences / Issue 11/2022
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI: https://doi.org/10.1007/s10620-021-07360-0

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Comparison of Different Endoscopic Methods Used for Managing Choledocholithiasis in Patients with End-Stage Renal Disease Undergoing Hemodialysis

Abstract

Background and Aim

Methods

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background and Aim

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2022

Intra-subject Variability in High Resolution Anorectal Manometry Using the London Classification: Diagnostic and Therapeutic Implications

Validation and Performance of FibroScan®-AST (FAST) Score on a Brazilian Population with Nonalcoholic Fatty Liver Disease

Can Exosomes Derived from Bone Marrow-Derived Stem Cells Help Heal Intestinal Ischemia/Reperfusion Injury?

Serial EUS-Guided FNA for the Surveillance of Pancreatic Cysts: A Study of Long-Term Performance of Tumor Markers

Impact of Celiac Disease on Dating

Increased Mortality in Patients Undergoing Inpatient Endoscopy During the Early COVID-19 Pandemic

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page