Difficult Common Bile Duct Stones: What To Do?

Aims Endoscopic retrograde cholangiopancreatography (ERCP) is the treatment of choice of common bile duct (CBD) stones, providing a complete clearance of the CBD in more than 90 % of cases. However, the presence of difficult stones can limit its results. Our work aimed to evaluate different techniques for managing difficult CBD stones as well as their results.

Methods It was a retrospective study, from March 2019 to October 2020, including all patients with difficult CBD stones, defined as a stone diameter ≥ 15mm, multiple stones, barrel-shaped stones, and tapering or tortuosity of the distal common bile duct, and scheduled for ERCP.

Results Out of 221 ERCPs, 31 patients (14.02 %) were admitted for difficult CBD stones. The mean age of the patient was 62.8 +/- 18 years, with a sex-ratio F/M of 1.8.The median diameter of the CBD and stones were 20 mm [16-25] and 16 mm [15-20], respectively. We notified 6 cases (19.4 %) of barrel-shaped stones. The tapering of the distal CBD was recorded in 5 patients, and it was identified as a limit of stone extraction when it exceeded 2 cm. We performed an endoscopic papillary large balloon dilation (EPLBD) after an endoscopic sphincterotomy (EST) in 19 patients(61.3 %) with a mean diameter balloon of 15.8 +/- 1.8 mm, and a large sphincterotomy (LS) alone was performed in 10 patients (32.3 %) associated to endoscopic mechanical lithotripsy in 02 patients.

The success of the ERCP was obtained in 90.3 % of patients (N = 28) and was guaranteed by EPLBD and LS.The hospital stay varied between 24-48 hours and no complication of EPLBD or LS was reported.

Conclusions EPLBD after EST and LS alone are two simple and effective techniques for endoscopic extraction of difficult CBD stones. In our series, they represent the two most used techniques with a success rate that exceeds 90 %.

Citation Ouardi wEl, Borahma M, Lagdali N et al. eP325 DIFFICULT COMMON BILE DUCT STONES: WHAT TO DO? Endoscopy 2021; 53: S204.

Publication History

Article published online:
19 March 2021