ERCP's efficacy in choledocholithiasis management, a retrospective study conducted in tertiary endoscopic center

Aims This study aims to evaluate the success of endoscopic management in CBD stone removal, analyze the epidemiological profile of affected patients (age, sex, prior cholecystectomy and clinical presentation), and assess the rate of endoscopic sphincterotomy, frequency of stent placement, and effectiveness of extraction tools.

Methods We conducted a monocentric retrospective study of descriptive and analytical type in the hepato-gastroenterology and interventional endoscopy department over (May 2016 – May 2024). From a total of 1959 ERCPs performed in 1416 patients, 1047 procedures (53%) were for choledocholithiasis in patients with an intact ampullary papilla.

Results The study included 808 patients: 551 women (68%) and 257 men (32%), W/M ratio:2. The mean age was 67±17 years [range: 10-106 years]. Age distribution was as follows:<15 years (0.2%), 15-30 years (3.8%), 30-45 years (10%), 45-75 years (52%), and>75 years (34%). History of cholecystectomy was present in 38% of cases. The primary clinical presentations were: acute cholangitis (55%), abdominal pain with jaundice (31%), and acute pancreatitis (10%). The cannulation of CBD was obtained in 91% of cases (n=753), revealing one stone in 42%, two stones in 12%, more than two stones in 37%, stone debris in 6%, and no stones in 3%. The average stone size was 13±7 mm (range: 3-58 mm). Endoscopic sphincterotomy was performed in 88% of cases (n=660), with a large sphincterotomy in 89% and a small one in 11%. The bile duct clearance was achieved in 71% of cases (n=539) primarily using a balloon catheter (97%). A biliary stent was placed in 19% of cases when extraction was not initially possible. Technical success, defined as successful stone removal or stent placement was achieved in 86% of cases and exceeded 90% following a second endoscopic attempt. Clinical success, indicated by symptom's improvement and reduction in bilirubin blood level, was observed in over 91% of cases.

Conclusions This study demonstrates that ERCP is an effective approach for managing CBD stones’, with high rates of technical and clinical success. ERCP also provides favorable outcomes for short– and long-term management, especially in patients with a history of cholecystectomy, reducing the need for more invasive surgical interventions.

Publication History

Article published online:
27 March 2025