How Should We Define A Large Common Bile Duct Stone ?

Aims The definition of a large stone is not clear ranging from 10 to 15 mm

(1) Some authors speak of a large stone if its size is greater than the diameter of the CBD by more than 2 mm (ratio size of the stone/diameter of the CBD> 1).

(2) The objective of our study was to identify the threshold at which the diameter of the stone becomes a cause of endoscopic treatment failure.

Methods This is a retrospective study that included all patients who had ERCP for common bile duct stones between January 2014 and December 2017. The threshold from which the diameter of the stone is predictive of the failure of the ERCP was identified by the analysis of the ROC curve.

Results We included 181 patients whose mean age was 64 years [22-103 years] with a sex ratio M/W = 0.41. The main indications for ERCP were residual or recurrent lithiasis (69 %, n = 129) or sequential treatment (18 %, n = 33). The success rate of the 1st line treatment was 61.5 %. The average stone size was 12.5mm [3-40mm]. On analysis of the ROC curve, the diameter that predicts endoscopic treatment failure in the most sensitive and specific way was 12 mm with a sensitivity of 74 % and a specificity of 73 %. In univariate analysis, a stone larger than 12 mm was a predictor of standard endoscopic treatment failure (p = 0.001). The ratio stone size/diameter of the CBD was on average equal to 0.74 [0.27-1.67]. In our series, this factor was not significantly associated with ERCP failure (p = 0.276).

Conclusions In our series, a stone size greater than 12 mm was a predictor of ERCP failure. The ratio stone size/diameter of the CBD was not significantly associated with endoscopic treatment failure.

Citation: Nakhli A, Sabbah M, Bellil N et al. OP191 HOW SHOULD WE DEFINE A LARGE COMMON BILE DUCT STONE ?. Endoscopy 2021; 53: S79.

Publication History

Article published online:
19 March 2021