Endosc Int Open 2017; 05(09): E809-E817
DOI: 10.1055/s-0043-107615
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Increased risk and severity of ERCP-related complications associated with asymptomatic common bile duct stones

Hirokazu Saito1, 2, Tatsuyuki Kakuma3, Yoshihiro Kadono4, Atsushi Urata4, Kentaro Kamikawa4, Haruo Imamura4, Shuji Tada1
  • 1Department of Gastroenterology, Kumamoto City-Hospital, Kumamoto, Japan
  • 2Department of Gastroenterology, Kumamoto Chuo Hospital, Kumamoto, Japan
  • 3Department of Biostatics Center, Medical School, Kurume University, Fukuoka, Japan
  • 4Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
Further Information

Publication History

submitted 09 November 2016

accepted after revision 06 February 2017

Publication Date:
05 September 2017 (online)

Abstract

Background and study aims Endoscopic removal of asymptomatic common bile duct stones (CBDS) is generally recommended. Although many reports have described the risk of complications in endoscopic retrograde cholangiopancreatography (ERCP), no studies have addressed this problem in the context of asymptomatic CBDS. This study examines the risk of complications arising in ERCP for asymptomatic CBDS.

Patients and methods This retrospective study included 425 patients with naive papilla who underwent therapeutic ERCP for choledocholithiasis at 2 institutions in Japan for 2 years. The risk of complications was examined in patients who were divided into the asymptomatic and symptomatic CBDS groups. We used propensity score analysis to adjust for confounding effects.

Results Complications were observed in 32 (7.5 %) of the 425 patients. Of the 358 patients with symptomatic CBDS, 14 patients (3.9 %) had complications. In contrast, of the 67 patients with asymptomatic CBDS, 18 patients (26.9 %) had complications. Propensity score analysis revealed that asymptomatic CBDS was a significant risk factor, with a significantly higher incidence of complications compared with symptomatic CBDS (odds ratio, 5.3). Moderate to severe complications were observed in 15 of 18 patients (83.3 %) in the asymptomatic CBDS group, with significantly more moderate to severe complications than those in the symptomatic CBDS (odds ratio, 6.7).

Conclusions Asymptomatic CBDS carried a high risk of ERCP-related complications, and these were often more severe. In asymptomatic CBDS, endoscopic treatment should be carefully performed after considering the patient’s background, and detailed explanation of its possible complications should be given to patients in advance.