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CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(10): E943-E951
DOI: 10.1055/a-2164-8557
Original article

Predictors of success of conventional ERCP for bile duct stones and need for single-operator cholangioscopy

Tareq El Menabawey  ‡
1   Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN8964)
,
Akhilesh Mulay‡
1   Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN8964)
,
David Graham
1   Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN8964)
,
Simon Phillpotts 
1   Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN8964)
,
Amrita Sethi
2   Gastroenterology and Hepatology, Columbia University Medical Center, New York, United States (Ringgold ID: RIN21611)
,
George J Webster
1   Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN8964)
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Abstract

Background and study aims The characteristics of difficult stones requiring cholangioscopy-assisted lithotripsy are poorly defined. We sought to determine clinician perception of these characteristics and decision-making in biliary endoscopy.

Methods One hundred twenty-four delegates attending an online course were invited to assess 20 clinical stone cases. Each image was graded on a 4-point Likert for: grading of stone difficulty, confidence of clearance with conventional endoscopic retrograde cholangiopancreatography (ERCP) methods, likelihood of needing cholangioscopy-assisted lithotripsy, and confidence of clearance with one session of lithotripsy. An independent reviewer rated each case on largest stone size, stone number, presence of stricture distal to stone, size of stone relative to distal duct size, and acute common bile duct (CBD) angulation < 135°. Multilevel (mixed) statistical methods with a two-level model were utilized with multilevel ordinal logistic regression.

Results Stone size and location, stricture and stone diameter:duct ratio impacted perceived procedural difficulty P < 0.01). Stone:duct ratio (< 50% odds ratio [OR] 0.22, P < 0.001), stricture (OR 7.26, P < 0.001) and stone location impacted confidence of clearance with conventional ERCP. Intrahepatic and cystic duct stones were least likely to engender confidence (P < 0.01). The same factors plus CBD angulation < 135° predicted cholangioscopy requirement (P < 0.01). Stone number did not influence procedure difficulty or cholangioscopy requirement. Strictures (OR 0.29, P < 0.001) and location, especially intrahepatic (OR 0.42, P < 0.001) impaired confidence in clearance with one cholangioscopy session.

Conclusions Ductal anatomy, the presence of a stricture distal to a stone, cystic and intrahepatic stones and stones larger than the distal duct are considered by endoscopists to be significant predictors of requiring cholangioscopy-assisted lithotripsy.

Keywords

Pancreatobiliary (ERCP/PTCD) - Cholangioscopy - Stones


Publication History

Received: 04 March 2023

Accepted after revision: 28 August 2023

Accepted Manuscript online:
01 September 2023

Article published online:
09 October 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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