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Polish Journal of Surgery

The Journal of Foundation of the Polish Journal of Surgery

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Endoscopic Treatment of the Choledocholithiasis - Effectiveness, Safety and Limitations of the Method

Tadeusz Peterlejtner1 / Tomasz Szewczyk1 / Piotr Firkowski1 / Michał Zdrojewski1

Department of General Surgery, Municipal Hospital in Olsztyn1

This content is open access.

Citation Information: Polish Journal of Surgery. Volume 84, Issue 7, Pages 333–340, ISSN (Print) 0032-373X, DOI: 10.2478/v10035-012-0056-6, August 2012

Publication History

Published Online:
2012-08-30

Endoscopic Treatment of the Choledocholithiasis - Effectiveness, Safety and Limitations of the Method

Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is accepted referred method of treatment of the choledocholithiasis

The aim of the study. Evaluation of efficacy and safety of the endoscopic treatment of the biliary tract stones.

Material and methods. Results of 3309 Endoscopic Retrograde Cholangio-Pancreatography (ERCP) carried out in Division of Endoscopy of the General Surgery Department in the period 2000 - 2010. The retrospective analysis of the indications, process, findings and final results of 1698 ERCP and Endoscopic Sphincterotomy (ES) was performed with intention to treat of the biliary tract stones.

Results. The 883 (52%)patients with coexisted gall-bladder and biliary tract stones were the principal group. The second group included 580 (34.2%) patients with residual choledocholithiasis after cholecystectomy and biliary tract surgery. Moreover ERCP, ES and endoscopic evacuation of biliary stones have been urgently carried out in 159 (9.4%) cases with acute biliary pancreatitis. Lastly ERCP with re-sphincterotomy and removal of the stones was performed in 75 (4.4%) patients with recurrent choledocholithiasis. The procedure was effective in 1561 (92%) patients. When removal of the stones was not possible, decompression of the biliary tract by implantation of the plastic stent was done in 63 (3.7%) cases. Ineffective procedure was noted in 74 (4.3%) patients. The most commonly observed complication was acute pancreatitis. Because of: post ES bleeding, acute haemmorhagic and necrotic pancreatitis, impacted Dormia basket and peripapillary duodenal perforation 10 patients (0.5%) had to be operated. Two patients (0.1%) died.

Conclusions. 1. Endoscopic treatment of choledocholithiasis is highly effective but risk factors of complications with urgency an intensive conservative management and surgical intervention have to be considered. 2. After ES, if surgical evacuation of the stones have to be carry out, post operative biliary tract drainage (by T tube) is not necessary.

Keywords: choledocholithiasis; endoscopic retrograde cholangio-pancreatography; endoscopic sphincterotomy

  • Classen M, Demling L: Endoskopische Sphinkterotomie der Papilla Vateri und Steinextraktion aus dem Ductus choledochus. Dtsch Med Wschr 1974; 99: 496-97. [CrossRef]

  • Kawai KY, Akasaka Y, Murakami K et al.: Endoscopic sphincterotomy of the ampulla of Vater. Gastrointest Endosc 1974; 20: 148-50. [CrossRef]

  • Bednarczyk J, Wojtuń S, Warczyńska A i wsp.: Rola ECPW w kwalifikacji do cholecystektomii laparoskopowej w dobie nowoczesnych badań obrazowych dróg żółciowych. Pol Merk Lek 2007; XXII, 131: 474-76.

  • Nowakowska-Duława E, Romańczyk T, Marek T: Endoskopowa cholangiopankreatografia wsteczna - przegląd piśmiennictwa z ostatnich 2 lat. Przegl Gastroenterol 2008; 3(4): 169-75.

  • Hogan WJ, Geenen JE: Biliary dyskinesia. Endoskopy 1988; 20 (Suppl. 1): 179-83.

  • Wojtun S, Gil J, Gietka W, Gil M: Endoscopic sphincterotomy for choledocholithiasis: A prospective single-center study on the short term and long-term results in 483 patients. Endoscopy 1997; 29(4): 258-65. [CrossRef]

  • Mc Alister VC, Davenport E, Renouf E: Cholecystectomy deferral in patients with endoscopic sphincterotomy. Cochrane Database Syst Rev 2007; Issue 4, Art. Nr.: CD006233. [Web of Science]

  • Cohen S, Bacon BR, Berlin JA et al.: Institutes of Health State of the Science Conference Statement: ERCP for diagnosis and therapy. Gastrointest Endosc 2002; 56(6): 803-09. [CrossRef]

  • Boerma D, Rauws E.A, Kuelmans YC et al.: Wait and see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile duct stones: a randomised trial. Lancet 2002; 360: 761-65.

  • Kohut M, Nowakowska-Duława E, Marek T et al.: Accuracy of linear endoscopic ultrasosnography in the evaluation of patients with suspected bile duct stones. Endoscopy 2002; 34(4): 299-303. [CrossRef]

  • Prat F, Edery J, Meduri B et al.: Early EUS of the bile duct before endoscopic sphincterotomy for acute biliary pancreatitis. Gastrointest Endosc 2001; 56(6): 724-29. [CrossRef]

  • Cotton PB, Garrow DA Gallagher J et al.: Risk factor for complications after ERCP: a multivariate analysis of 11497 procedures over 12 years. Gastrointest Endosc 2009; 70: 80-88. [Web of Science]

  • Freeman ML: Adverse outcome of ERCP. Gastrointest Endosc 2002; 56(6) Suppl: 273-82. [CrossRef]

  • Enns R, Baillie J: Review article: the treatment of acute biliary pancreatitis. Aliment Pharmacol Ther 1999; 13: 1379-89. [CrossRef] [PubMed]

  • Nitsche R, Folsch UR: Role of ERCP and endoscopic sphincterotomy in acute pancreatitis. Bailliere's Clinical Gastroenterol 1999; 13(2): 331-43.

  • Neoptolemos JP, London NJ, James D et al.: Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones. Lancet 1988; 8618(2): 979-83.

  • Fan ST, Lai EC S, Mok FPT et al.: Early treatment of acute biliary pancreatitis by endoscopic papillotomy. NEJM 1993; 328(4): 228-32.

  • Nowak A, Nowakowska-Duława E, Marek T et al.: Final results of prospective, randomized, controlled study on endoscopic sphincterotomy versus conventional managament in acute biliary pancreatitis. Gastroenterology 1995; 108: A380.

  • Van Dam J, Sivak MV Jr: Mechanical lithotripsy of large common bile duct stones. Cleve Clin J Med 1993; 60(1): 38-42. [CrossRef]

  • Chang WH, Chu CH, Wang TE et al.: Outcome of simple use of mechanical lithotripsy of difficult common bile duct stones. World J Gastroenterol 2005; 11: 593-96.

  • Li K W, Hang X W, Ding J et al.: A prospective study of the efficacy of endoscopic biliary stenting on common bile duct stones. J Dig Diseases 2009; 10: 328-31. [Web of Science]

  • Katsinelos P, Kountouras J, Paroutoglou G et al.: Combination of endoprostheses and oral ursodeoxycholic acid or placebo in the treatment of difficult to extract common bile duct stones. Dig Liver Dis 2008; 40: 453-59. [Web of Science] [CrossRef]

  • Huibregtse K, Katon RM, Tytgat GNJ: Precut papillotomy via fine-needle knife papillotome: a safe and effective technique. Gastrointest Endosc 1986; 32: 403-05. [CrossRef] [PubMed]

  • Mavrogiannis C et al.: Needle knife fistulotomy versus needle-knife precut papillotomy for the treatment of common bile duct stones. Gastrointest Endosc 1999; 50: 334-39. [CrossRef]

  • Hui C-K, Lai K-C, Yeun M-F et al.: Acute cholangitis - predictive factors for emergency ERCP. Aliment Pharmacol Ther 2001; 15: 1633-37. [CrossRef]

  • Nowakowska-Duława E, Nowak A, Kaczor R: Doraźna sfinkterotomia endoskopowa w ostrym zaporowym zapaleniu dróg żółciowych. Pol Arch Med Wewn 1991; 85(2): 107-11.

  • Chack A, Cooper GS, Lloyd LE et al.: Effectiveness of ERCP in cholangitis: a community based study. Gastrointest Endosc 2000; 52(4): 484-89. [CrossRef]

  • Loperfido S, Angelini G, Benedetti G et al.: Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 1998; 48(1): 1-10. [CrossRef]

  • Vandervoort J, Soetikno R, Tham TCK et al.: Risk factor for complications after performance of ERCP. Gastrointest Endosc 2002; 56(5): 552-56.

  • Rochester J: Risk of Endoscopic Retrograde Cholangiopancreatography and Sphincterotomy. Techniques Gastrointest Endosc 2008; 10(1): 14-21. [CrossRef]

  • Wojtun S, Gil M, Gil J: Recognition of ERCPinduced pancreatitis in patients with choledocho-lithiasis by an analysis of laboratory findings. Hepato-Gastroenterology 2000; 47(32): 550-53.

  • Testoni PA, Vailati C, Giussani A et at.: ERCP-induced and non ERCP induced acute pancreatitis: Two distinct clinical entities with different outcomes in mild and severe form. Digestive and Liver Disease 2010; 42: 567-70. [Web of Science] [CrossRef]

  • Schutz SM, Chinea C, Friedrichs P: Succesful endoscopic removal of a severed impacted Dormia basket. Am J Gastroenterol 1998; 92: 679-81.

  • Sauter G, Sackmann M, Holl J et al.: Dormia basket impacted in the bile duct: release by extracorporeal shock-vawe lithotrypsy. Endoscopy 1995; 27: 384-87. [CrossRef]

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