Advanced ERCP techniques for the extraction of complex biliary stones: a single referral center's 12-year experience

• Published in: Scandinavian journal of gastroenterology 2018-05, Vol.53 (5), p.626-631
• Main Authors: Brown, Nicholas G., Camilo, Joel, Nordstrom, Eric, Yen, Roy D., Fukami, Norio, Brauer, Brian C., Wani, Sachin, Amateau, Stuart K., Attwell, Augustin R., Shah, Raj J.
• Format: Article
• Language: English
• Subjects: biliary stones; cholangioscopy; Choledocholithiasis; ERCP; lithotripsy
• ISSN: 0036-5521; 1502-7708
• DOI: 10.1080/00365521.2018.1441434

Objectives: Advanced ERCP techniques (AETs) for difficult biliary stones include peroral cholangioscopy (POC) with electrohydraulic/laser lithotripsy (EHL/LL), endoscopic papillary large balloon dilation (EPLBD) and mechanical lithotripsy (ML). We assess the efficacy of AETs. Methods: A retrospective query for AETs. Primary outcome: Complete duct clearance. Secondary outcome: Complete duct clearance by technique. Statistical Analysis version 9.3 (SAS Inc., Cary, NC). Results: From 1/00 to 10/12, 349 patients were identified of which 222 (80% had prior ERCPs) had AETs. 211 with sufficient follow-up underwent 295 ERCPs; 280 of which were AET's. Index AETs: POC with EHL/LL (n = 46/211, 22%), ML (n = 84/211, 40%), EPLBD with mean balloon size of 11.5 ± 1.7 mm (n = 39/211, 18%) and combination AETs (n = 42/211, 20%). Stone characteristics: 76% had ≥1 stone, 81% extrahepatic and 32% had strictures. Number of stones (mean 2.5 and range 1-20) did not differ among groups. EPLBD had higher percentage (95%) of extrahepatic stones (p = .0003). The 'Combination' and 'POC' groups had larger stones (mean 17.7 mm ±6.4 and 16.8 mm ±6.1, respectively; p