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

Tareq El Menabawey; Akhilesh Mulay; David Graham; Simon Phillpotts; Amrita Sethi; George J Webster

doi:10.1055/a-2164-8557

Endoscopy International Open, Table of Contents

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 ‡

¹Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN8964)

,

Akhilesh Mulay‡

¹Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN8964)

,

David Graham

¹Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN8964)

,

Simon Phillpotts

¹Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN8964)

,

Amrita Sethi

²Gastroenterology and Hepatology, Columbia University Medical Center, New York, United States (Ringgold ID: RIN21611)

,

George J Webster

¹Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN8964)

› Author Affiliations

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

Full Text

References

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