CHOLANGIOSCOPY IN COMMON BILE DUCT STONE DISEASE: TWO YEAR EXPERIENCE AT A NON-TERTIARY CENTER

Aims Single operator cholangioscopy (SOC) has been use in our centre since 2016. The aim of this study was to assess the efficacy and safety of SOCP for common bile duct (CBD) stone disease in our high volume non-tertiary endoscopic retrograde cholangiopancreatography (ERCP) center.

Methods A prospectively maintained database was retrospectively interrogated for all subjects undergoing SOC from September 2016 to November 2018. Unique patient identification numbers were cross referenced with the endoscopy database and electronic record. Patient demographics, procedure indication, success rates and complication rates were recorded.

Results A total of 24 patients (Male = 10, 41.7% Female = 14, 58.3%) underwent 31 procedures. Median age was 74 years old (IQR 36–93). The median Charleston Comorbidity Index was 4

(IQR 0–7). 13 (54.2%) had at least one co-morbidity.

Median stone size was 18 mm (IQR10-30), 17(70.8%) had multiple stones.6 (25%) patients had SOC on their index ERCP. 9 (37.5%) had one previous ERCP with failed duct clearance. An equal number had 2 or more previous ERCPs with failed duct clearance.

Complete duct clearance was achieved in 17 (70.8%) patients. 12 (50%) had duct clearance after the first procedure, 4 (16.7%) after 2 procedures and 1 after 3 procedures. Of those without duct clearance, 5 were deemed too frail to continue with therapy, all of these had stones greater than 20 mm and all had had previous attempts at duct clearance with ERCP.

There were three (12.5%) procedure related adverse events. One patient had a desaturation event with Propofol sedation and there were two episodes of cholangitis.

Conclusions We report on an older age group of patients with an increased burden of co-morbidities undergoing SOC for stone disease. There were low rates of complete duct clearance limited mostly by frailty. Despite this there were low rates of complications associated with the procedure.