Aims The management of main bile duct lithiasis (MBDL) has changed considerably since
the introduction of endoscopic sphincterotomy (ES), which is now emerging as the treatment
of choice.The aim of our work is to demonstrate the efficacy of ES in the management
of main tract lithiasis, and to highlight its low complication rate [1]
[2]
[3]
[4].
Methods We conducted a retrospective descriptive study spanning a 2-year period from December
2021 to December 2023. All patients with residual main bile duct lithiasis treated
by endoscopic retrograde cholangio-pancreatography (ERCP) with ES were included. Successful
ES was defined by achieving vacuity of the main bile duct. Quantitative variables
were described in terms of means and standard deviations, while qualitative variables
were described in terms of numbers and percentages.
Results We included 80 patients in our study, the mean age was 61 years [28-84y]. The sex
ratio was 0.59 (47 women and 33 men). Of 69 patients who underwent Bili-MRI prior
to surgery, lithiasis of the main bile duct was visible in 75% of cases. The mean
lithiasis size was 7.3 mm [3 -17mm]. Median operative time was 48min [25min – 90min].
The success rate of endoscopic treatment was 86.6%. We noted an evacuation failure
in 8.75% of patients (n=7). These patients received a plastic prosthesis. Complications
numbered 10%: 6 cases of pancreatitis (7.5%), 2 cases of hemorrhage (2.5%).
Conclusions Endoscopic sphincterotomy is currently the gold standard in the management of large
stones or impactions of the main bile duct.
