Difficult common bile duct stones – The recipe for success: A Single-Center experience

Aims Although endoscopic retrograde cholangiopancreatography (ERCP) is the main treatment of common bile duct (CBD) stones, succeeding clearence in more than 90% of cases, the presence of difficult stones can limit its results. Aim of our study was to present our experience in difficult CBD stones treatment.

Methods It was a retrospective study, from January 2020 to October 2022, including all patients (pts) with difficult CBD stones, defined as a stone diameter ≥ 12mm and/or multiple stones of distal CBD.

Results Totally 283 pts were included (M/F: 134/149, mean age 62 ±14.5 [22-90] years). Out of 283 ERCPs, 96 pts (33.9%) were admitted with difficult CBD stones. We performed a large sphincterotomy (LS) alone in 73 (76%) and an endoscopic papillary balloon dilation at 13mm (EPBD) after an endoscopic sphincterotomy (EST) in 22 pts (23%). The success rate (SR) of LS and the combination of EST and EPBD were 85% (62/73) and 72.7% (16/22) respectively. In cases that both techniques failed, we performed cholangioscopy and electrohydraulic lithotripsy (EHL) with a success rate >95%. The total ERCP SR was 95.8% (92/96). No complication of EPBD, LS or EHL was reported during the 24-hour hospital stay.

Conclusions LS alone and EPBD combined with EST are two simple and effective techniques for endoscopic extraction of difficult CBD stones (SR=81%). In our cases, EHL through cholangioscopy constituted an effective assist for difficult CBD stones after EPBD or LS. The combination of these 3 techniques performed a SR that exceeds 95%. Cholangioscopy is a technique that should be widely performed due to its high SR and low complication rate.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publikationsverlauf

Artikel online veröffentlicht:
14. April 2023