Advanced ERCP techniques for the extraction of complex biliary stones: a single referral center's 12-year experience. (4th May 2018)

• Record Type: Journal Article
• Authors: Brown, Nicholas G.; Camilo, Joel; Nordstrom, Eric; Yen, Roy D.; Fukami, Norio; Brauer, Brian C.; Wani, Sachin; Amateau, Stuart K.; Attwell, Augustin R.; Shah, Raj J.
• Is Part Of: Scandinavian journal of gastroenterology. Volume 53:Number 5(2018)
• Page Start: 626
• Page End: 631
• Publication Date: 2018-05-04
• Subjects: Choledocholithiasis -- ERCP -- lithotripsy -- cholangioscopy -- biliary stones; Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; 616.33
• DOI: 10.1080/00365521.2018.1441434
• Languages: English
• ISSNs: 0036-5521

Abstract

Abstract: Objectives: Advanced ERCP techniques (AETs) for difficult biliary stones include peroral cholangioscopy (POC) with electrohydraulic/laser lithotripsy (EHL/LL), endoscopic papillary large balloon dilation (EPLBD) and mechanical lithotripsy (ML). We assess the efficacy of AETs. Methods: A retrospective query for AETs. Primary outcome: Complete duct clearance. Secondary outcome: Complete duct clearance by technique. Statistical Analysis version 9.3 (SAS Inc., Cary, NC). Results: From 1/00 to 10/12, 349 patients were identified of which 222 (80% had prior ERCPs) had AETs. 211 with sufficient follow-up underwent 295 ERCPs; 280 of which were AET's. Index AETs: POC with EHL/LL ( n = 46/211, 22%), ML ( n = 84/211, 40%), EPLBD with mean balloon size of 11.5 ± 1.7 mm ( n = 39/211, 18%) and combination AETs ( n = 42/211, 20%). Stone characteristics: 76% had ≥1 stone, 81% extrahepatic and 32% had strictures. Number of stones (mean 2.5 and range 1–20) did not differ among groups. EPLBD had higher percentage (95%) of extrahepatic stones ( p = .0003). The 'Combination' and 'POC' groups had larger stones (mean 17.7 mm ±6.4 and 16.8 mm ±6.1, respectively; p < .001). Complete clearance: 209/211 (99%) at index AET 167/211 (79%) or after mean of 2.5 ± 0.7 AETs in 42/211 (20%). Partial clearance: 2/211 (1%). Clearance at index AETs was higher with EPLBD (90%, p = .014). Adverse Events: 7/280 (2.5%). Conclusions: AETs achieved clearance in 99%. EPLBD had higher clearance at index AET likely owing to higher extrahepatic stones. Larger stones, but not number, were associated with increased combination AETs and total ERCPs.