NOVEL FENESTRATED ENDOSCOPIC SPHINCTEROTOMY FACILITATES HIGH DUCT CLEARANCE OF LARGE COMMON BILE DUCT STONES 10 TO 20MM IN SIZE IN PATIENTS WITH NAïVE AMPULLAS

Aims:

To assess the duct clearance of large CBD stones 10 mm to 20 mm in size.

Methods:

Electronic recording system (EndoRaad) was used to identify all patients that met our inclusion criteria: CBD stone ≥10 mm and ≤20 mm. Exclusion criteria: previous sphincterotomy, biliary strictures and where the intention was to provide biliary drainage alone and not duct clearance (pregnancy, coagulopathy and patients deemed too frail for intervention). Demographics, duct clearance rates (at index and subsequent procedures), number and size of CBD stones, and anatomical variants were recorded. SPSS v22 was used for statistical analysis.

Results:

105 consecutive patients were analysed. Duct clearance rate was 82.9% (87/105) at index ERCP, and 95.2% (100/105) with further ERCP. Only 11.4% (12/105) of patients required use of ML at index ERCP. 13 patients achieved duct clearance on further ERCP; 2 required ML and sphincteroplasty, 5 ML alone and 2 sphincteroplasty alone. 3 patients didn't require further modality beyond balloon trawl to clear duct on repeat ERCP. 5 patients failed endoscopic therapy to clear duct; 4 had distal CBD tapering and 1 patient had an impacted stone.

Conclusions:

FES enables high duct clearance with low utilization of further endoscopic modalities in CBD stones 10 mm to 20 mm in size. Our novel technique does not require additional resources, beyond training in technique itself, to implement in clinical practice.