TAVAC: Choledochoscopy Disposable Scopes, and the Single-stage Vs. Two-stage Approach to Choledocholithiasis

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2023 Jul 18

PMID 37464066

Authors

Salvatore Docimo Jr

Iswanto Sucandy

Andrew Luhrs

Tim Snow

David Pechman

Affiliations

Soon will be listed here.

Abstract

Background: Previous studies have been published evaluating the benefits and drawbacks of clearing the common bile duct of stones using a single-stage approach (LCBDE + LC) versus a two-stage approach (ERCP followed by LC). These studies have demonstrated that a single-stage approach offers similar outcomes and morbidities as a two-stage approach, with the added benefit of a lower cost and shorter length of stays. However, it is significant we understand why LCBDE is not commonly performed currently and also the lapse in surgical trainee exposure and competence in LCBDE. This paper aims to address the lapse in surgical trainee exposure to LCBDE, evaluate the scopes currently available to perform LCBDE, and review current data evaluating the risks and benefits of single-stage versus two-stage approaches to.

Methods: We utilized PubMed to analyze all publications related to the various disposable scopes utilized to perform choledochoscopy. We also discuss the need for disposable scopes and how this new market niche is transforming the choledochoscopy space.

Results: We analyzed the data related to single-stage and two-stage approach to choledocholithiasis. We noted an overall shorter length of stay and also decreased costs in favor of a single-stage approach.

Conclusion: A single-stage LCBDE is the most cost-effective treatment option for choledocholithiasis in patients with choledocholithiasis undergoing a cholecystectomy. In addition, single-stage approach is associated with shorter length of stay. Knowledge of the available choledochoscopes and tools available to surgeons to perform choledochoscopy is significant. The evidence does support the use of disposable choledochoscope from a cost and cross-contamination perspective. Additionally, efforts should be made to incorporate LCBDE into the teaching paradigm of surgical training programs.

Citing Articles

Minimally Invasive Common Bile Duct Stone Management in Gastric Bypass Patients: Laparoscopic Common Bile Duct Exploration with Disposable Bronchoscope.

Jazi A, Mahjoubi M, Shahabi S, Kermansaravi M, Safari S, Adib R Obes Surg. 2024; 34(7):2553-2561.

PMID: 38822904 DOI: 10.1007/s11695-024-07317-y.

Comparison of 1-stage and 2-stage Managements for Common Bile Duct Stones and Gallstones (CBDS): A Retrospective Study.

Zhou J, Chen Y, Yu S, Wang H, Wang Y, Chen Q J Clin Gastroenterol. 2024; 59(3):269-275.

PMID: 38648497 PMC: 11809737. DOI: 10.1097/MCG.0000000000002009.

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