Endoscopic treatment of large common bile duct stones

Aims Therapeutic endoscopic retrograde cholangiopancretography (ERCP) is the first approach in the management of bile duct stones. It is estimated that bile ducts can be cleared in 90% of the cases with conventional endoscopic methods. Large stones, however, can be sometimes challenging to remove. The aim of our study was to investigate the management and the complications associated with large common bile duct stones.

Methods We realized a retrospective study including all patients that undergone an ERCP between 2018 and 2024. The patients who had common bile duct stones were divided into two groups:

First group: those who had large common bile duct stones (>=10mm).

Second group: patients with smaller common bile duct stones.

Results During the study period, a total of 810 ERCP was performed. The majority (66%) were indicated to remove common bile duct stones. The mean age of the patients was 62,3 years old (10-99) with a sex ratio (F/M) of 1,3. Large stones have been found in 26,9% of the procedures (n=144). In both groups of patients, an acute biliary pancreatitis or cholangitis was associated in 36% of the cases. Bile duct clearance was obtained respectively in 79,8% and 90,6% within the first and second group. When it came to large stones, lithotripsy was performed in 5 patients, we placed a nasobiliary catheter once and a biliary endoprostheses in 14 patients. Among the second group, a biliary endoprostheses was needed 5 times. No difference was found in terms of short term ERCP complications between the two groups (0,349).

Conclusions Large common bile duct stones may require additional techniques while ERCP to be removed with difficulty to obtain bile duct clearance. However, they do not cause more short term complications than smaller bile duct stones.

Publication History

Article published online:
27 March 2025