ENDOSCOPIC TREATMENT OF LARGE CHOLEDOCHAL STONES AND CHOLEDOCHAL STONING: SUCCESS RATE, COMPLICATIONS AND ASSOCIATED FACTORS

Aims:

Evaluate the success rate, the factors influencing and the complications of endoscopic treatment of large choledochal stones and choledochal stoning.

Methods:

Retrospective study between January 2007 and December 2016. 678 patients were included and had ERCP for lithiasis of MBD. The choledochal stoning was defined by multiple obstructive stones (> 3) and large stone by an obstructive one (size> 15 mm).

Results of ERCP were compared in patients with choledochal stoning and/or large stone (group I) versus those with simple MBD lithiasis: ≤3 and/or non obstructive (group II). Success of endoscopic treatment was defined by the absence of residual stone in the MBD at the end of procedure.

Results:

Group I accounted for 42.5% of MBD lithiasis and group II for 57.5%. Success rate at the end of a single catheterization was 90.2% in group II versus 64% in group I (p < 0.001). A second ERCP was noted in 18.2% in group I versus 4.7% in group II (p < 0.001). Complementary maneuvers were performed in 37.3% in group I versus 6.7% in group II. Overall success rate after second ERCP and/or additional maneuvers was 96.9% in group II versus 92.8% in group I (p = 0.006). Overall rate of early complications was 6.5% in group II versus 8.2% in group I (p = 0.45). In univariate analysis, factors that significantly decreased the overall success of endoscopic treatment were: age, cholangitis, periampullary diverticulum, stenosis of MBD and significant dilation of this one (diameter> 15 mm). In multivariate analysis, only presence of angiocholitis (OR = 0.30 CI 95% [0.11 – 0.80] p = 0.01) and periampullary diverticulum (OR = 0.22 CI 95% [0.07 – 0.64] p = 0.005) were associated with decreased overall success of endoscopic treatment.

Conclusions:

Complementary maneuvers allowed in our series to bring the success of treatment to 92.8% with a rate of complication that remains acceptable. Presence of angiocholitis and periampullary diverticulum appear to be two factors associated with decreasing the overall success of endoscopic treatment