Endoscopy 2020; 52(S 01): S153
DOI: 10.1055/s-0040-1704472
ESGE Days 2020 ePoster Podium presentations
Thursday, April 23, 2020 14:30 – 15:00 ERCP: Leaks and blood ePoster Podium 2
© Georg Thieme Verlag KG Stuttgart · New York

IMAGING FINDING OF SMALL STONES IS ASSOCIATED TO A HIGHER RISK OF UNNECESSARY ERCP: RESULTS OF A RETROSPECTIVE, MULTICENTER STUDY

P Andreozzi
1   Gastroenterology and Endoscopy Unit, ASL Caserta, Marcianise Hospital, Marcianise, Italy
,
GD Nucci
2   Department of Gastroenterology, ASST Rhodense ~ Rho and Garbagnate M.se Hospitals, Milan, Italy
,
M Devani
2   Department of Gastroenterology, ASST Rhodense ~ Rho and Garbagnate M.se Hospitals, Milan, Italy
,
D Redaelli
2   Department of Gastroenterology, ASST Rhodense ~ Rho and Garbagnate M.se Hospitals, Milan, Italy
,
M Schettino
2   Department of Gastroenterology, ASST Rhodense ~ Rho and Garbagnate M.se Hospitals, Milan, Italy
,
D Iuliano
3   Gastoenterology and Endoscopy Unit, ASL Caserta, Marcianise Hospital, Marcianise, Italy
,
M Gagliardi
4   Endoscopic Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
,
A Maurano
4   Endoscopic Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
,
ME Bottiglieri
1   Gastroenterology and Endoscopy Unit, ASL Caserta, Marcianise Hospital, Marcianise, Italy
,
G Paspatis
5   Gastroenterology Department, Benizelion General Hospital, Heraklion, Greece
,
M Dinelli
6   Gastroenterology and Endoscopy Unit, San Gerardo Hospital, Monza, Italy
,
G Manes
2   Department of Gastroenterology, ASST Rhodense ~ Rho and Garbagnate M.se Hospitals, Milan, Italy
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Publikationsdatum:
23. April 2020 (online)

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Aims Common bile duct stones (CBDS) can migrate spontaneously through the duodenal papilla. ERCP for small CBDS may be thus unnecessary and is likely to carry a significant rate of complications. We aim at retrospectively evaluating the rate of spontaneous stone passage in patients with an imaging diagnosis of CBDS.

Methods We conducted a retrospective multi-center analysis of patients undergoing ERCP for CBDS in a 12-month period. ERCPs with failed biliary cannulation were excluded. Data regarding patients´ characteristics, imaging findings and ERCP procedure were analysed.

Results 532 patients (69.5±17.5 years, female 55.6%) were included in the analysis. Imaging revealed presence of sludge in 34 patients (6.4%), single stone in 245 patients (46.1%), 2 or more stones in 253 patients (47.5%). At ERCP, CBDS were not found in 91 patients (17.1%). Pancreatitis as indication (OR:3.661 C.I.95%:1.441-9.301), imaging finding of sludge (OR:3.582 C.I.95%:1.439-8.916), < 5 mm stones (OR:2.943 C.I.95%:1.671-5.185) and interval >7 days between imaging and ERCP (OR:1.982 C.I.95%:1.020-3.849) were associated to the absence of CBDS at ERCP. Absence of CBDS was observed in 26% of patients with sludge or ≤5 mm stones and 10.6% of those with > 5mm stones at imaging (p< 0.001). In patients with imaging finding of ≤ 5 mm stones, the rate of negative ERCP increased according to the time occurring from the imaging diagnosis and ERCP (< 7 days:22.8%, 7-30 days:41.4%, >30 days:45.5%; p=0.036). No significant differences in terms of complications was observed between the two groups

Conclusions Small CBDS may migrate spontaneously in up to 45% of patients. Diagnosis of sludge, < 5 mm stones and a delay in ERCP >7 days were predictive factors for spontaneous migration. We suggest that CBDS < 5 mm should not undergo immediate removal. Prospective studies are needed to confirm these results and demonstrate the safety of a conservative management in this setting.