ENDOSCOPIC TREATMENT OF PATIENTS WITH «DIFFICULT» BILE DUCT STONE DISEASE

Aims To estimate the possibility of mechanical lithotripsy (ML), endoscopic balloon dilation (BD) of post endoscopic sphincterotomy area (post-ERCP area) or combination of these methods in treatment of «difficult» common bile duct stones.

Methods Retrospective single center study of endoscopic management of difficult bile duct stones was held at the Pirogov Russian Medical University at the Moscow City Hospital #31 from January 2013 to July 2019.

There were 1356 cases of common bile duct stones including 247 (18,2%) cases of «difficult» bile stone disease. There were less than 3 stones in 167cases (67,6%). Mean size of the largest stone was 16,9 ±5,5 mm. Mean balloon size used for BD was 14,21±3,1 mm (10-20 mm).

Results General success rate was 93,5% (231). Complete clearance after index procedure was achieved in 224 (90,7%) cases. General complication rate was 3.2%, mortality rate - 1.6%.

ML was carried out in 23.5% (58) of cases, success after first procedure was achieved in 87,9%(51) of cases. Complication rate was 6,9%. Complications included 1case of perforation, 3 case of post-ERCP pancreatitis. Mortality rate - 3,5%.

BD was performed in 49,8% (123) of cases, success rate after index procedure was 92,7% (114). Complication rate was 3,3%. Complications after BD included 2 cases of post-EPT bleeding, 1 case of perforation, 1 case of post-ERCP pancreatitis. Mortality rate was 0,81% (one death).

In cases of BD failure, it was combined with ML (66, 26,7%). Success rate after index procedure was 89,4% (59).

Complication rate was 3% (2). Mortality rate - 1,5% (1).

Conclusions Balloon dilation of the post-ERCP area in treatment of «difficult» common bile duct stones is more effective and less traumatic procedure than ML. In cases, when BD of post-ERCP area is unsuccessful, combination of BD with ML may help to achieve total common bile duct clearance with comparable complication level.