Overall Success and Factors Predicting Failure for Endoscopic Extrahepatic Biliary Stone Extraction.
- Author:
Soon Koo BAIK
1
;
Jun Myung KIM
;
Kwang Hyun KIM
;
Yon Soo JEONG
;
Dong Ki LEE
;
Sang Ok KWON
Author Information
1. Department of Internal Medicine Wonju College of Medicine, Yonsei University.
- Publication Type:Original Article
- Keywords:
Extrahepatic bile duct stone;
Endoscopic management
- MeSH:
Bile;
Bile Ducts;
Cholangiopancreatography, Endoscopic Retrograde;
Cholecystitis, Acute;
Common Bile Duct;
Constriction, Pathologic;
Gallbladder;
Gastric Bypass;
Hemorrhage;
Hepatic Duct, Common;
Humans;
Lithotripsy;
Pancreatitis;
Retrospective Studies;
Risk Factors;
Sepsis;
Shock;
Sphincterotomy, Endoscopic
- From:Korean Journal of Medicine
1998;54(4):523-532
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
OBJECTIVES: Developments in endoscopic technique and equipments have improved duct clearance rate in patients with extrahepatic bile duct(EHBD) stone. In this study, we reviewed our experience in extracting EHBD stones with standard and more advanced technique and equipments such as mechanical lithotripsy and extra corporeal shock wave lithotripsy. Aims of this study were to determine the overall success rate of endoscopic ex tracting for EHBD stone, to identify risk factors for failed duct clearance at initial and final therapeutic ERCP. METHODS: We retrospectively reviewed 214 consec utive patients who underwent Endoscopic Retrograde Cholangiopancreatography(ERCP) for EHBD stone over 45 months period. Factors evaluated for failed duct clearance included stone size, stone number, stone shape, concomitant stone of gallbladder and intrahepatic duct, presence of distal bile duct stricture, periampullary diverticula(PAD), Billroth-II gastrojejunostomy, and sepsis at admission. RESULTS: The overall success rate of endoscopic treatment for EHBD stone was 93.5% (200/214). The causes of failed duct clearance were failed endoscopic sphincterotomy in 5/214 (2.3%), technical failure of extracting stone in 5/214(2.3%), and aggravation of acute cholecystitis between therapeutic endoscopic sessions in 4/214(1.9%). Risk factors for failed duct clearance with endoscopic extraction of EHBD stone were size and shape of the stone, concomitant stone of gallbladder and intra hepatic duct, and stricture of distal common bile duct. The duct clearance rate with initial therapeutic ERCP was 56.5%(121/200). Risk factors for failed duct clearance with initial therapeutic ERCP were size, shape and number of stone, and sepsis at admission. The com plications of endoscopic treatment for EHBD stone were major bleeding in 5/200 (2.5%), pancreatitis in 18/200 (9.0%), but there was no perforation. CONCLUSION: Eventhough risk for failure of endo scopic treatment for EHBD stone were giant or piston shaped stone, concomitant stone of gallbladder and intra hepatic duct, and stricture of distal common bile duct, we conclude that endoscopic treatment for EHBD stone is safe and effective treatment modality, and choice of treatment.
