SPYING BACK TO STONE AGE, PREPARING FOR THE FUTURE OF BILIARY STONES EXTRACTION – A DECADE LONG EXPERIENCE WITHOUT LIGHT BEAMS

Aims:

To evaluate the efficacy of endoscopic extraction methods before the use of cholangioscopy assisted laser and electrohydraulic lithotripsy.

Methods:

We conducted a retrospective single center study over 10 years from 2009 to 2018. We included in the study 2865 patients with single or multiple bile duct stones submitted to ERCP. We analyzed each technique of extraction in correlation with the following parameters: mean diameter of the stone/stones (MDS), mean diameter of the common bile duct (MDCBD) and success rate (SR) defined by number of cases solved endoscopically vs. cases of residual lithiasis/referred to surgery. Colledata were processed in IBM SPSS Statistics 20.

Results:

Patients with choledocholithiasis underwent different endoscopic extraction techniques: basket, retrieval balloon, lithotriptor, combined methods ± balloon dilator. Endoscopic success rate was 92%. 153 patients (5.3%) were referred to surgery because endoscopic techniques failed, while 60 patients (2%) had residual lithiasis after ERCP despite using more than 2 methods of extraction. This fact was statistically correlated to high values of MDS and MDCBD. Stones with a mean diameter of 6 mm were extracted only by using basket or retrieval balloon, while stones with a diameter of more than 14 mm were treated by surgery (p < 0.05). The same situation was encountered for MDCBD, which was higher than 17 mm in the surgery group and lower than 13 mm in ERCP group. Between these values fitted in the groups of patients treated by combined endoscopic techniques.

Conclusions:

Stone extraction success rates were never 100% (92% in our study), and larger stones need combined techniques. Looking back at this decade long data, the new cholangioscopy assisted lithotripsy techniques used on a larger scale will make the difference and surgical treatment will be rare in the future.