Endoscopic Treatment of the Choledocholithiasis - Effectiveness, Safety and Limitations of the Method

Abstract

Results. The 883 (52%)patients with coexisted gall-bladder and biliary tract stones were the principal group. The second group included 580 (34.2%) patients with residual choledocholithiasis after cholecystectomy and biliary tract surgery. Moreover ERCP, ES and endoscopic evacuation of biliary stones have been urgently carried out in 159 (9.4%) cases with acute biliary pancreatitis. Lastly ERCP with re-sphincterotomy and removal of the stones was performed in 75 (4.4%) patients with recurrent choledocholithiasis. The procedure was effective in 1561 (92%) patients. When removal of the stones was not possible, decompression of the biliary tract by implantation of the plastic stent was done in 63 (3.7%) cases. Ineffective procedure was noted in 74 (4.3%) patients. The most commonly observed complication was acute pancreatitis. Because of: post ES bleeding, acute haemmorhagic and necrotic pancreatitis, impacted Dormia basket and peripapillary duodenal perforation 10 patients (0.5%) had to be operated. Two patients (0.1%) died. conclusions. 1. Endoscopic treatment of choledocholithiasis is highly effective but risk factors of complications with urgency an intensive conservative management and surgical intervention have to be considered. 2. After ES, if surgical evacuation of the stones have to be carry out, post operative biliary tract drainage (by T tube) is not necessary.

Acute Biliary Pancreatitis in Cholecystectomised Patients

“…In our series, prevalence of such diverticula was 4.5%. A previous study found that ABP was more frequent after cholecystectomy in patients with choledochal diameter greater than 10 mm [15–19]. In our series, choledochal diameter of all patients was greater than normal.…”

ERCP in a cohort of 759 cases: A 6-year experience of a single tertiary centre in Libya

“…This wide discrepancy in successful cannulation in these studies can be the result of differences in operator experience in performing this procedure or due to various anatomical factors such as the deep location of the ampulla of Vater in periampullary diverticula, the deformations or strictures of the pylorus and duodenum, or postgastrectomy anatomical changes [17,18]. In the present study, the bile duct cannulation rate (88.3%) is acceptable as it was successfully performed in all except 11.7% of the patients.…”