Aims Common Bile Duct Stones (CBDS) is a common indication for ERCP. There are British
Society of Gastroenterology endorsed national standards for clearance rates with the
expectation that 75% or more of initial ERCPs for CBDS should result in stone clearance(1).
This paper will examine the NHS data set from all trusts in England to assess the
treatment of CBDS.
Methods Using ICD-10 codes defined by an accredited clinical coder we examined the Hospital
Episode Statistics (HES) data from England from 2013/4 to 2018/9 and selected those
who had their initial bile duct stones presentations in 2015/6 to 2016/7. We followed
this cohort of patients throughout the period of time from their presentation to the
end of 2019 financial year and assessed how many ERCPs each patient underwent. We
therefore had 2 years of patients with a primary diagnosis of bile duct stones with
at least 2 years of follow up. All data is limited to NHS hospitals.
Results Over the 4 year follow up period 86,602 of the 183,503 ERCPs (47.2%) done were for
CBDS. Within the 2015/6 to 2016/7 cohort was made of 37,468 patients who needed 55,556
ERCPs. 26,146 had only 1 ERCP, which, at best, represents a CBDS clearance rate at
first ERCP of 69.8%. In addition, the remaining 11,322 (30.2%) patients required 29,410
ERCPs, demonstrating that 52.9% of ERCPs undertaken for those who had an initial CBDS
presentation between 2015/16 and 2016/17 were repeat procedures. There is a is significant
regional as well as trust variation in those needing more than 1 ERCP for CBDS.
Conclusions We are falling below the minimum standards required for stone clearance at ERCP,
leading to findings that more than 50% of ERCPS for CBDS are repeat procedures. The
reasons for this require further study, but the burden of cost is significant
