Outcomes Of The Endoscopic Treatment In Biliary Panlithiasis

Aims Biliary panlithiasis (BP) is defined by the presence of multiple lithiasis (more than 3) in the main bile duct (MDB). The aim of our work was to assess the rate of lithiasis extraction failure during BP and the associated factors.

Methods During a period of 5 years, all patients with a BP who underwent a therapeutic ERCP were collected. Patients with difficult or impossible MDB catheterization were excluded. A univariate then multivariate analysis using binary logistic regression was performed (p significant if <0.05).

Results Among 861 patients who underwent an ERCP during the period of the study, 582 patients were referred for lithiasis of the MDB; 171 had BP (29.3 %). The average age of our patients was 64 [18-98] and the sex ratio M/F was 0.54. The indication for ERCP was: residual lithiasis of the MDB in 54 % of the cases, sequential treatment in 18 % of the cases, acute biliary pancreatitis in 16 % of the cases and acute cholangitis in 11 % cases. The diagnosis of BP was made by per cholangiography in 11 % of the cases. Extraction failure was noted in 19 % of patients, 75 % of whom had a biliary prosthesis inserted. Acute pancreatitis was the main complication noted in 5 % of cases. In a univariate analysis, the factors related to stone extraction failure were; female gender (p = 0.04), severe acute cholangitis (p < 0,001), residual MDB lithiasis (p < 0,001) and acute biliary pancreatitis (p < 0,001). In a multivariate analysis, two factors have been identified; severe acute cholangitis (OR = 5) and acute biliary pancreatitis (OR = 3).

Conclusions Although ERCP seems to be a safe and effective technique for the treatment of BP, it remains a challenge in a 1/5 of cases. The factors associated with the extraction failure were severe cholangitis and acute biliary pancreatitis.

Citation Temani MK, Mahmoudi M, Bradai S et al. eP326 OUTCOMES OF THE ENDOSCOPIC TREATMENT IN BILIARY PANLITHIASIS. Endoscopy 2021; 53: S204.

Publication History

Article published online:
19 March 2021