Benefits of a second ERCP in the treatment of common bile duct stones after a primary failure

Aims Failure of ERCP in the treatment of common bile duct stones (CBDS) could be dueeither to unsuccessful bile duct cannulation or to unsuccessful stone extraction. In this cases, it’spossible to interrupt the procedure, and repeat the ERCP after a short interval.Thus, the aim of the present study was to determine the outcomes of repeating ERCP in patients in whom the first ERCP failed

Methods A total of 498 patients with a naive papilla, that underwent ERCP betweenthe years of 2017-2022, were retrospectively reviewed. Data from our databases were analyzed.Efficacy was based on the biliary cannulation and stone extraction rates of the second ERCP.

Results In our series, papilla cannulation failed in 31 cases (6.3%). Among these patients, eight underwent a second ERCP, with success in all cases. Therefore, the overall bile duct cannulation rate has raised from 93,77% (467/498) to 95.38% (475/498) after a second ERCP. Bile duct stones were found during ERCP in 321 patients. Complete stone extraction has failed in 32 patients (9,96%), among them, 26 had a biliary stent placed while a nasobiliary drain was placed in 3 patients. A second attempt at stone extraction was made in 10 patients with biliary stents in place within a 62-day timeframe, with a success rate of 90% (9/10). The overall bile duct clearance rate has raised therefore from 90.03% (289/321) at initial procedure to 92.83% after a second ERCP.

Conclusions A second ERCP seems to be a worthwhile option following initial failed biliary cannulation. The placement of a biliary drainage and repeating ERCP is also an effective strategy for managing failed CBDS extraction.

Publication History

Article published online:
27 March 2025