Major predictors for difficult common bile duct stone

Üsküdar, Oǧuz; Parlak, Erkan; Dışıbeyaz, Selçuk; Köksal, Aydın Şeref; Çıçek, Bahattin; Kılıç, Zeynep; Ödemiş, Bülent; Şaşmaz, Nurgül

doi:10.4318/tjg.2013.0511

Cited by 20 publications

(26 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[12] In our study, we did not find an association between stone size and the failure to clear the biliary system on the index ERCP; again, this could be due to the fact that only a small proportion had large CBD stones in our cohort (9.6% had a stone larger than 15 mm) as well as the fact that endoscopists could have utilized advanced endoscopic techniques to clear these stones during the index ERCP. The presence of a stricture below a stone is an intuitive cause for increased difficulty in extracting a stone, which was the case in our study and is consistent with the literature[18] where a stemware-shaped CBD was associated with a bile duct clearance rate on the index procedure of only 41.2%; even in those with stones less than 1 cm in size, the clearance rate on the index procedure was only 62.5% while the overall procedure-related adverse events were relatively high, that is, 14.7%. [11] In addition, the presence of an angulation in the distal CBD has been thought to be a cause of decreased clearing rates of the biliary system[4] but was not the case in our cohort.…”

Section: Discussionsupporting

confidence: 92%

“…Although stone characteristics like the number or size and relation to the CBD diameter were not found to be associated with the stone clearance rates in studies,[12] this is in contrast to others[11151718] where larger stones (≥17.7 ± 6 mm) were found to require a combination of advanced ERCP techniques to achieve duct clearance. [12] In our study, we did not find an association between stone size and the failure to clear the biliary system on the index ERCP; again, this could be due to the fact that only a small proportion had large CBD stones in our cohort (9.6% had a stone larger than 15 mm) as well as the fact that endoscopists could have utilized advanced endoscopic techniques to clear these stones during the index ERCP.…”

Section: Discussionmentioning

confidence: 70%

See 1 more Smart Citation

Predictors of failure of endoscopic retrograde cholangiography in clearing bile duct stone on the initial procedure

Almadi

Eltayeb

Thaniah

et al. 2019

Saudi J Gastroenterol

View full text Add to dashboard Cite

Background/Aims: The aim of this study is to predict cases where the clearance of the biliary system from stones at the initial endoscopic retrograde cholangiopancreatography (ERCP) might be of value for better risk-stratifying patients. We attempted to identify factors that are associated with a higher failure rate of clearing the biliary system on the index ERCP. Patients and Methods: This is a retrospective study from January 2008 to January 2015. All patients with bile duct stones confirmed on ERCP were included in this study. Patients who had prior attempts of bile duct stone extraction were excluded. Results: A total of 554 ERCPs were performed to extract biliary duct stones from 426 patients. The mean age was 46.3 years and 41.7% were males. The group where the index ERCP did not clear the biliary system tended to be older (50.4 vs. 45.2 years, P = 0.03). On multivariate analysis, the presence of fever (OR 4.64; 95% CI, 1.66–12.79), a larger number of filling defects (OR 1.34; 95% CI, 1.13–1.93), presence of a stricture distal to a stone (OR 4.63; 95% CI, 1.36–15.78), the use of an extraction basket (OR 3.23; 95% CI, 1.56–6.74), and/or mechanical lithotripsy (OR 3.05; 95% CI, 1.10–8.49) were all associated with a lower odds of clearing the biliary system. The use of an extraction balloon was associated with the success of clearing the biliary system (99.7% vs. 77.4%, P < 0.01) and a lower odds of failing (OR 0.01; 95% CI, 0.00–0.08) on multivariate analysis. Conclusion: A few of the characteristics that are found on cholangiography at the index ERCP could be used to identify patients that might require more than one ERCP to clear the biliary system from stones.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 70%

Predictors of failure of endoscopic retrograde cholangiography in clearing bile duct stone on the initial procedure

Almadi

Eltayeb

Thaniah

et al. 2019

Saudi J Gastroenterol

View full text Add to dashboard Cite

show abstract

“…However, existence of periampullary diverticula did not show any association with difficult stones. There are reports that support our findings while there are others that suggest the opposite [2, 6, 7, 9]. Probably these diversions are due to differences in ERCP experience of the reporting centers.…”

Section: Discussionsupporting

confidence: 73%

“…Recent literature has reported that difficult stones can be seen in 7–20% of patients while in our study we have similarly experienced difficult stones in 13.6% of patients, and additional interventions were indicated [3, 6–9]. We have observed that general features of the patients with difficult stones are similar to the recent literature, such as older age, dilation of the CBD, impaction of the stone, stricture distal to the stone, and opening anomaly of the papilla [1, 6, 9]. Additionally, it must be noted that patients with difficult stones had higher bilirubin levels, while they had relatively lower hepatic enzyme levels.…”

Section: Discussionsupporting

confidence: 62%

Endoscopic Management of the Difficult Bile Duct Stones: A Single Tertiary Center Experience

Ödemiş

Kuzu

Öztaş

et al. 2016

Gastroenterology Research and Practice

View full text Add to dashboard Cite

Background. Most common bile duct (CBD) stones can be removed with standard techniques using endoscopic retrograde cholangiopancreatography (ERCP), but in some cases additional methods are needed. In this study we aimed to investigate the management of patients with difficult stones and the factors that affect the outcome of patients that have undergone periodic endobiliary stenting. Materials and Methods. Data of 1529 patients with naive papilla who had undergone ERCP with an indication of CBD stones was evaluated retrospectively. Stones that could not be removed with standard techniques were defined as “difficult stones.” Cholangiograms of patients who had difficult stones were revised prospectively. Results. Two hundred and eight patients (13.6%) had difficult stones; 150 of these patients were followed up with periodic endobiliary stenting and successful biliary clearance was achieved in 85.3% of them. Both CBD (p < 0.001) and largest stone size (p < 0.001) were observed to be significantly reduced between the first and the last procedure. This difference was even more significant in successfully treated patients. Conclusions. Periodic endobiliary stenting can be used as an effective treatment for patients with difficult stones. Sizes of the CBD and of the largest stone are independent risk factors that affect the success rate.

show abstract

“…The introduction into clinical practice of baskets of various sizes and configurations (3)(4)(5), various lithotripsy methods (6,7) considerably increased the possibilities and the safety of their endoscopic debridement. Sufficient clinical material made it possible to significantly improve the "tactics of X-ray endoscopic treatment of choledocholithiasis" (8,9), assessing its potential (10,11). Despite this, there are still clinical observations when it is necessary to perform an open laparotomy with choledocholithotomy sometimes against the background of not only high obstructive jaundice, but also purulent cholangitis, which does not always end in the patient's recovery (12,13).…”

Section: Introductionmentioning

confidence: 99%

Possibilities of endobiliary stenting with complex choledocholithiasis

Yurchenko¹,

Uzakov²

2019

HVT

View full text Add to dashboard Cite

Objective: To increase the effectiveness and safety of endosurgical treatment of choledocholithiasis. Methods: The set goal is achieved by studying the causes of unsatisfactory results of lithoextractions, improving its tactics and technology. Patients with known predictors of the futility of lithoextraction were excluded from the study. Based on the study of other causes of inefficiency namely strangulation of calculi with a basket, progression of obstructive jaundice, the addition of purulent cholangitis or postpapillotomy bleeding some new tactical rules and endosurgical techniques were formulated. Their effectiveness was tested in group of patients. Results: When comparing the research and control groups, a decrease in the frequency of endosurgical treatment of choledocholithiasis was revealed. Conclusion: The effectiveness of the proposed tactical principles and technological techniques has been proved. Key words: endoscopic papillosphinctertomy, endoscopic lithoextraction, obstructive jaundice, purulent cholangitis, postpapillotomy bleeding.

show abstract

Major predictors for difficult common bile duct stone

Abstract: Girifl ve

Cited by 20 publications

References 10 publications

Predictors of failure of endoscopic retrograde cholangiography in clearing bile duct stone on the initial procedure

Predictors of failure of endoscopic retrograde cholangiography in clearing bile duct stone on the initial procedure

Endoscopic Management of the Difficult Bile Duct Stones: A Single Tertiary Center Experience

Possibilities of endobiliary stenting with complex choledocholithiasis

Contact Info

Product

Resources

About