Current Situation of Endoscopic Treatment for Common Bile Duct Stones

Sakai, Yuji; Tsuyuguchi, Toshio; Sugiyama, Harutoshi; Nishikawa, Takao; Tawada, Katsunobu; Saito, Masayoshi; Kurosawa, Jo; Mikata, Rintaro; Tada, Motohisa; Ishihara, Takeshi; Yokosuka, Osamu

doi:10.5754/hge12048

Cited by 8 publications

(8 citation statements)

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“…Patients with cirrhosis have poor coagulation function and are at risk for bleeding; therefore, they require more care during surgery, resulting in longer operative times and an increased risk of postoperative pancreatitis. Studies have shown that cholangitis, coagulation disorders, cholecystectomy, history of jaundice, emergency procedures, intramural sphincter injection, sphincter pressure measurement, and biliary drainage are not risk factors for postoperative pancreatitis [13,14] . A controversial point is whether the experience of endoscopic operators is meaningful to the occurrence of pancreatitis after ERCP.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown that cholangitis, coagulation disorders, cholecystectomy, history of jaundice, emergency procedures, intramural sphincter injection, sphincter pressure measurement, and biliary drainage are not risk factors for postoperative pancreatitis. [ 13 , 14 ] A controversial point is whether the experience of endoscopic operators is meaningful to the occurrence of pancreatitis after ERCP. Notably, a lack of experience and a lower skill level of the operator will significantly increase the occurrence of errors and the risk of postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of risk factors associated with endoscopic retrograde cholangiopancreatography for patients with liver cirrhosis: a multicenter, retrospective, clinical study

et al. 2022

Chinese Medical Journal

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Background: Endoscopic retrograde cholangiopancreatography (ERCP) is the endoscopic modality of choice for the treatment of biliary and pancreatic diseases. However, patients with cirrhosis, particularly those with decompensated cirrhosis, are believed to be at increased risk for complications associated with ERCP. There is a paucity of literature describing the outcomes of ERCP for patients with cirrhosis. This study aimed to investigate the outcomes of ERCP for cirrhosis patients, especially adverse events, and evaluated its safety and efficacy. Methods: We performed a multicenter, retrospective study of all patients at

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Analysis of risk factors associated with endoscopic retrograde cholangiopancreatography for patients with liver cirrhosis: a multicenter, retrospective, clinical study

et al. 2022

Chinese Medical Journal

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“…[ 6 ] The most effective and standard treatment for bile duct stones is endoscopic retrograde cholangiopancreatography (ERCP). [ 7 ] However, in 10% to 15% of cases, additional techniques are required, [ 8 ] typically due to a large stone size (>15 mm) and/or the tapering of the distal bile duct. Endoscopic papillary large balloon dilation (EPLBD), which consists of lithotomy without lithotripsy and dilation of the papilla using a large balloon, was first described by Ersoz et al [ 8 ] in 2013 as a technique to address challenging cases.…”

Section: Introductionmentioning

confidence: 99%

“…A recent systematic review has shown that, among patients with acute cholecystitis, the incidence of common bile duct stones varies from 2.4% to 25%, with an estimated pooled incidence of 13.7% [6] . The most effective and standard treatment for bile duct stones is endoscopic retrograde cholangiopancreatography (ERCP) [7] . However, in 10% to 15% of cases, additional techniques are required, [8] typically due to a large stone size (>15 mm) and/or the tapering of the distal bile duct.…”

Section: Introductionmentioning

confidence: 99%

Long-term effects of endoscopic papillary large balloon dilation in patients with challenging bile duct calculi

et al. 2021

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Endoscopic papillary large balloon dilation (EPLBD) can be used to treat challenging common bile duct stones. No previous studies have reported intractable cases treated either by EPLBD or mechanical lithotripter use. We aimed to evaluate and compare the long-term effects of EPLBD with mechanical lithotripter use. This retrospective cohort study reviewed data from 153 patients admitted to the Eastern Chiba Medical Center from April 2014 to March 2020, presenting with common bile duct calculi that could not be removed using a basket or balloon catheter. Patients were divided into groups depending on whether the treatment was performed using a mechanical lithotripter or EPLBD. The primary outcome was the recurrence rate of common bile duct calculi, and the secondary outcome was the rate of postoperative adverse events. The Wilcoxon test was used to compare the 2 groups. Statistical significance was set at P < .05. The median age of patients included in the lithotripter and EPLBD groups were 73 years and 83 years, respectively ( P = .006), while the sex ratio (male:female) in the groups was 18:13 and 55:67, respectively. The EPLBD group showed a statistically larger median bile duct diameter (13 mm [range: 8–24 mm] vs 11 mm [range: 5–16 mm]; P < .001), larger maximal calculus diameter (median, 13.5 mm [range: 8–25 mm] vs 11 mm [range: 7–16 mm]; P < .001), and shorter median cumulative treatment time after reaching the duodenal papilla (35.5 minutes [range: 10–176 minutes] vs 47 minutes [range: 22–321 minutes]; P = .026) in comparison to the lithotripter group. There was no significant difference in the rate of adverse events between the EPLBD and the mechanical lithotripter groups. The recurrence rate was significantly lower ( P = .014) in the EPLBD group. EPLBD increases therapeutic efficacy and reduces treatment duration for patients in whom calculus removal is difficult, without increasing the frequency of adverse events. No serious adverse events were observed. Additionally, EPLBD appears to reduce the risk of long-term recurrence. Future studies are needed to evaluate long-term outcomes in younger patients.

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“…Endoscopic retrograde cholangiopancreatography (ERCP) has become the first-choice treatment for common bile duct (CBD) disorders and periampullary disease 12. Compared with other endoscopic examinations, ERCP carries a higher potential for complications, ranging from minor events with prompt resolution, such as mild pancreatitis, to major life-threatening risks, such as hemorrhage and severe pancreatitis 34567.…”

Section: Introductionmentioning

confidence: 99%

Bleeding Complications and Clinical Safety of Endoscopic Retrograde Cholangiopancreatography in Patients with Liver Cirrhosis

et al. 2019

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Purpose Patients with liver cirrhosis are considered to be at risk for additional adverse events during endoscopic retrograde cholangiopancreatography (ERCP). The present study was designed as a propensity-score matched analysis to investigate whether cirrhotic liver increases the risk of bleeding complications in patients undergoing ERCP. Materials and Methods In total, 8554 patients who underwent ERCP from January 2005 to December 2015 were retrospectively analyzed. To adjust for the imbalance between patients with and those without liver cirrhosis, 1:3 propensity score matching was performed according to age and sex. Results Liver cirrhosis was identified in 264 (3.1%) patients. After propensity score matching, a total of 768 patients were included in each of the cirrhotic (n=192) and non-cirrhotic groups (n=576). Post-procedure bleeding (10.9% vs. 4.7%, p =0.003) was more frequently observed in patients with liver cirrhosis than in those without. In multivariate analyses, liver cirrhosis was identified as an independent risk factor associated with post-ERCP bleeding ( p =0.003) after further adjustment for prothrombin time, antiplatelet/coagulant, duration of ERCP, and stent insertion. Child-Pugh (CP) class C was found to be associated with an increased incidence of post-ERCP bleeding in patients with cirrhosis (odds ratio 6.144, 95% confidence interval 1.320–28.606; p =0.021). Conclusion The incidence of post-ERCP bleeding in patients with liver cirrhosis was higher than that in patients without liver cirrhosis. In particular, CP class C cirrhosis was significantly associated with post-ERCP bleeding.

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Current Situation of Endoscopic Treatment for Common Bile Duct Stones

Abstract: Common bile duct stones can be endoscopically treated safely with high rate.

Cited by 8 publications

References 0 publications

Analysis of risk factors associated with endoscopic retrograde cholangiopancreatography for patients with liver cirrhosis: a multicenter, retrospective, clinical study

Analysis of risk factors associated with endoscopic retrograde cholangiopancreatography for patients with liver cirrhosis: a multicenter, retrospective, clinical study

Long-term effects of endoscopic papillary large balloon dilation in patients with challenging bile duct calculi

Bleeding Complications and Clinical Safety of Endoscopic Retrograde Cholangiopancreatography in Patients with Liver Cirrhosis

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