Digital SpyGlass Confirmed Common Bile Duct Stones Clearance Without Fluoroscopy
Digital SpyGlass Confirmed Common Bile Duct Stones Clearance Without Fluoroscopy
This study aim to evaluated the effectiveness of Digital SpyGlass Cholangioscopy to
 facilitate common bile duct stone removal without fluoroscopy
Patients This study recruited patients who suspected/confirmed CBDS from clinical
 manifestation, liver function tests and imaging studies. With CBD sized between 5 and 15
 millimeters, which measured from transabdominal ultrasonography (US), computed tomography
 (CT), magnetic resonance cholangiopancreatography (MRCP) or endoscopic ultrasonography (EUS).
 The exclusion criteria were history of bile duct surgery, bile duct stricture, bile duct
 tumors, severe comorbid diseases, unstable vital signs, pregnancy, and coagulopathy. All
 patients were informed and wrote informed consent for the procedure.

 Procedures Non-fluoroscopic CBDS removal was performed by experienced endoscopists, using
 standard side-viewing duodenoscope. After identified major papilla, the investigators
 performed bile duct cannulation with guidewire assisted technique. Successful cannulation
 confirmed by visualized bile aspiration. If the patients had difficult cannulation, double
 guidewire technique was used. After the successful bile duct cannulation, the investigators
 performed endoscopic standard sphincterotomy (EST). Precut sphincterotomy was not used in
 this study. Non fluoroscopic balloon extraction was performed. The balloon was pushed up to
 hilum then the investigators sweep until suspected complete CBD clearance. After that the
 investigators used digital SpyGlassTM to confirm the complete clearance of CBDS. If
 SpyGlassTM showed residual CBD stone, the investigators repeat balloon extraction. If
 SpyGlassTM showed complete clearance, the investigator proceed to perform final cholangiogram
 as reference standard for this study.
Inclusion Criteria:

 -  Patients with clinically suspected/confirmed CBDS

 -  CBD caliber 5-15 mm

 Exclusion Criteria:

 -  History of bile duct surgery

 -  History of bile duct tumor

 -  History of bile duct stricture

 -  Severe comorbidity

 -  Unstable vital signs

 -  Pregnancy

 -  Coagulopathy