scholarly journals O-L03 Safety and Efficacy of Endoscopic Retrograde Cholangiopancreatography for Removal of Common Bile Duct Stones in the Nonagenarians: A Single Tertiary Centre Experience

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Sijjad Ijaz ◽  
Amaan Khan ◽  
Mohammed Gariballa ◽  
Mustafa Jalal ◽  
Yasser Amer Al-Joudeh
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Statistical Significance ◽  
Anticoagulation Therapy ◽  
Endoscopic Retrograde ◽  
Safety And Efficacy ◽  
Cbd Stones ◽  
Group A ◽  
Group B

Abstract Background It is estimated that one in four persons in the UK will be > 65 years old by 2050. Endoscopic retrograde cholangiopancreatography (ERCP) is the recommended therapy for removals of common bile duct (CBD) stones. There is a lack of UK data on the outcome of ERCP in the very elderly. We aimed to investigate the safety and efficacy of ERCP in the management of CBD stones in the elderly >90 years old compared with those aged 65-89 years old. Methods We retrospectively analysed patients undergone ERCP between 2016-2020. Those with conditions other than suspected CBD stones were excluded. The following data was collected: general demographics, comorbidities, American Association of Anaesthesiology (ASA) grading, presence of dementia, anticoagulation therapy, endoscopic report on completed intention of treatment which is defined by either removal of stone and/or stent insertion. Also, post-procedure complications were collected including post-ERCP pancreatitis (PEP), bleeding, perforation, cholangitis, respiratory, and cardiovascular (CVS) events. Readmission within 7 days and death within 30 days were collected. Outcomes were reported as mean ± (SD) or n (%). Statistical significance was considered when P < 0.05. Results Total, 126 patients ≥ 90 years(group A) compared to 262 patients aged 65-89 years(group B). Higher rate of dementia, and anticoagulation therapy in Group A (17.4%) vs (0.4%),p <0.0001 and (36.5%) vs (17.9%),p <0.0001,respectively. Completed treatment was achieved in group A(90.5%) compared to group B(89.9%),p 0.7. One patient (0.8%) had PEP group A compared to 8(3.1%) group B,p 0.3. Overall complications (13.5%) group A vs (9.5%) group B,p 0.3. Four cases (3.2%) died within 30-day in group A compared to group B 5 (1.9%), p 0.5. There was no procedure-related death Conclusions ERCP for removal of CBD stones in > 90 years old is effective. Risk of post-ERCP pancreatitis and overall adverse events were not higher in the > 90 years compared to 65-89 years old. We report a 30-day mortality rate of 3.2%. The most common cause of death was pneumonia including COVID-19 peumonia.

scholarly journals Two-stages using endoscopic retrograde cholangio-pancreatography procedures versus single stage laparoscopic management for concomitant gallstones and common bile duct stones

2019 ◽  
Vol 6 (12) ◽  
pp. 4244 ◽  
Author(s):  
Ahmed Abdel Kahaar Aldardeer ◽  
Alaa A. Redwaan
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Single Stage ◽  
Complication Rates ◽  
Bile Duct Stones ◽  
Two Stage ◽  
Endoscopic Retrograde ◽  
Cbd Stones ◽  
Group A ◽  
Group B

Background: Laparoscopic common bile duct exploration (LECBD) has been proven to be a safe, reliable, and effective treatment for common bile duct (CBD) stones and has gained wider acceptance. Endoscopic retrograde cholangio-pancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) is safe and efficient method that has been usually used for the treatment of bile duct stones. The aim of this study is to compare the outcome of management of concomitant gallstones and common bile duct by two stage (ERCP+LC) versus one stage (LECBD+LC).Methods: This study included 150 patients with concomitant gallstones and CBD stones who were treated at sohag university hospital from July 2017 to December 2018. Results were statistically analysed.Results: The success rates of laparoscopic CBD exploration and ERCP for clearance of CBD were similar (Group A 96% vs. Group B 97.3%). The mean operative time was significantly longer in-group A (125.7±36.6 min) vs. in-group B (82.4±27.6 min), Group A as regard intraoperative complications (one patient had hemorrhage) vs. group B (2 patients hemorrhage during lap. cholecystectomy). As for conversion to other procedure 2 patients for group A vs. 3 patients for group B (conversion of LC to open).Conclusions: Single and two-stage management for uncomplicated concomitant gallbladder and CBD stones had similar success and complication rates, but the single stage strategy was better in terms of shorter hospital stay, need for fewer procedures, less morbidity, and allows earlier recovery with a reduced period of short-term disability. 

scholarly journals Adding ursodeoxycholic acid to the endoscopic treatment and common bile duct stenting for large and multiple biliary stones: Will it improve the outcomes?

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ahmad Hormati ◽  
Mohammad Reza Ghadir ◽  
Seyed Saeed Sarkeshikian ◽  
Faezeh Alemi ◽  
Majid Moghaddam ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Ursodeoxycholic Acid ◽  
The Elderly ◽  
Success Rates ◽  
Biliary Stones ◽  
Cbd Stones ◽  
Group A ◽  
Bile Duct Stenting ◽  
Group B

Abstract Background The role of common bile duct (CBD) stenting in the establishment of bile stream in the elderly patients and the ones who are not good candidates for surgery due to not responding to treatments was well documented in previous studies. The current study aimed at investigating the effect of adding Ursodeoxycholic acid (UDCA) to CBD stenting alone in order to reduce the size of large and multiple CBD stones. Methods Clinical outcomes including success rates in CBD stones clearance, incidence of pancreatitis, perforation, bleeding, as well as, decrease in size of stones and liver enzymes after a two-month period were assessed in the UDCA + CBD stenting group. Results A total of 64 patients referring to Shahid Beheshti Hospital in Qom, Iran with multiple or large CBD stones (above three or larger than 15 mm) received standard endoscopic therapies and UDCA + CBD stenting (group B) and controls only received standard endoscopic therapies with only CBD stenting (group A). The mean reduction in the size of stones in group B was significantly higher than that of group A (3.22 ± 1.31 vs 4.09 ± 1.87 mm) (p = 0.034). There was no difference in the incidence rate of complications including pancreatitis, cholangitis, bleeding, and perforation between the two groups (P > 0.05). Conclusion Adding UDCA to CBD stenting, due to decrease in the stone size and subsequently facilitation of the stones outlet, can be considered as the first-line treatment for patients with large and multiple CBD stones. Also, in the cases with large or multi stones may be effective in reducing size and subsequently stone retrieval. Trial registry The study protocol was approved by the Ethics Committee of Qom University of Medical Sciences (ethical code: IR.MUQ.REC.1397.075); the study was also registered in the Iranian Registry of Clinical Trials (No. IRCT20161205031252N8). This study adheres to CONSORT guidelines.

scholarly journals Detection of Common Bile Duct Stones in Mild Acute Biliary Pancreatitis Using Magnetic Resonance Cholangiopancreatography

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
David Aranovich ◽  
Veacheslav Zilbermints ◽  
Natalia Goldberg ◽  
Oleg Kaminsky
Keyword(s):  
Bile Duct ◽  
Magnetic Resonance ◽  
Common Bile Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Biliary Pancreatitis ◽  
Acute Biliary Pancreatitis ◽  
Cbd Stones ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background. All patients with mild acute biliary pancreatitis should undergo early cholecystectomy. Whether routine common bile duct (CBD) imaging should be employed before the surgical procedure in these patients is a matter of current controversy. The aim of this study was to investigate the rate of detection of CBD stones using magnetic resonance cholangiopancreatography (MRCP) at different time intervals from admission. Methods. From January 1, 2011, through December 31, 2016, 72 patients with acute biliary pancreatitis underwent MRCP. Fifty-six (n=56) of them with mild biliary pancreatitis met the study criteria. The patients were divided into two groups. Group A did not have stones in the CBD (n=45), and Group B had stones in the CBD (n=11). The time from admission to MRCP was divided into several periods (day 1 through day 180), and the presence of the CBD stones on MRCP was weighted against remoteness from admission. Liver chemistry profiles were compared between the groups on admission and before the MRCP. Results. The cumulative rate of choledocholithiasis was 19.7% (Group B, n=11). Forty-five patients (Group A, n=45, 80.3%) did not have gallstones in the CBD. Eight patients with choledocholithiasis (8/56, 14.2%) were detected during the first 10 days from admission out of 27 patients. In patients who underwent MRCP between days 11 and 20, choledocholithiasis was found in two patients (2/56, 3.5%) and in one patient between days 21 and 30 (1/56, 1.8%). No stones were found in patients who underwent MRCP beyond 30 days from admission. Liver chemistry profiles did not show a significant difference in both groups. CBD dilatation was observed at presentation in 11 patients (n=11/56), 6 in Group A (6/45, 13.3%) and 5 in Group B (5/11, 45.5%) (p=0.016). Conclusions. Routine CBD evaluation should be encouraged after mild acute biliary pancreatitis. Early performance of MRCP gives high yield in selecting the patients for endoscopic retrograde cholangiopancreatography (ERCP) before cholecystectomy. A liver chemistry profile either on admission or before MRCP cannot predict the presence of CBD stones.

scholarly journals Migration of Surgical Clips into the Common Bile Duct after Laparoscopic Cholecystectomy

2017 ◽  
Vol 10 (3) ◽  
pp. 787-792 ◽  
Author(s):  
Krishn Kant Rawal
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Acute Cholangitis ◽  
Endoscopic Retrograde ◽  
Surgical Clips ◽  
Cbd Stones ◽  
The Common ◽  
Retained Stones

Laparoscopic cholecystectomy (LC) is currently the treatment of choice for symptomatic gallstones. Associated complications include bile duct injury, retained common bile duct (CBD) stones, and migration of surgical clips. Clip migration into the CBD can present with recurrent cholangitis over a period of time. Retained CBD stones can be another cause of recurrent cholangitis. A case of two surgical clips migrating into the common bile duct with few retained stones following LC is reported here. The patient had repeated episodes of fever, pain at epigastrium, jaundice, and pruritus 3 months after LC. Liver function tests revealed features of obstructive jaundice. Ultrasonography of the abdomen showed dilated CBD with few stones. In view of acute cholangitis, an urgent endoscopic retrograde cholangiopancreatography was done, which demonstrated few filling defects and 2 linear metallic densities in the CBD. A few retained stones along with 2 surgical clips were removed successfully from the CBD by endoscopic retrograde cholangiopancreatography after papillotomy using a Dormia basket. The patient improved dramatically following the procedure.

scholarly journals Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography for the Treatment of Common Bile Duct Stones in Patients with Roux-en-Y Gastrectomy: Outcomes and Factors Affecting Complete Stone Extraction

2021 ◽  
Vol 10 (15) ◽  
pp. 3314
Author(s):  
Taisuke Obata ◽  
Koichiro Tsutsumi ◽  
Hironari Kato ◽  
Toru Ueki ◽  
Kazuya Miyamoto ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Papilla Of Vater ◽  
Stone Extraction ◽  
Endoscopic Retrograde ◽  
Double Balloon Enteroscopy ◽  
Factors Affecting ◽  
Balloon Enteroscopy ◽  
Cbd Stones

Background: Endoscopic retrograde cholangiopancreatography (ERCP) for extraction of common bile duct (CBD) stones in patients with Roux-en-Y gastrectomy (RYG) remains technically challenging. Methods: Seventy-nine RYG patients (median 79 years old) underwent short-type double-balloon enteroscopy-assisted ERCP (sDBE-ERCP) for CBD stones at three referral hospitals from 2011–2020. We retrospectively investigated the treatment outcomes and potential factors affecting complete stone extraction. Results: The initial success rates of reaching the papilla of Vater, biliary cannulation, and biliary intervention, including complete stone extraction or biliary stent placement, were 92%, 81%, and 78%, respectively. Of 57 patients with attempted stone extraction, complete stone extraction was successful in 74% for the first session and ultimately in 88%. The adverse events rate was 5%. The multivariate analysis indicated that the largest CBD diameter ≥14 mm (odds ratio (OR), 0.04; 95% confidence interval (CI), 0.01–0.58; p = 0.018) and retroflex position (OR, 6.43; 95% CI, 1.12–36.81; p = 0.037) were independent predictive factors affecting complete stone extraction achievement. Conclusions: Therapeutic sDBE-ERCP for CBD stones in a relatively elderly RYG cohort, was effective and safe. A larger CBD diameter negatively affected complete stone extraction, but using the retroflex position may be useful for achieving complete stone clearance.

scholarly journals Factors related to the spontaneous passage of common bile duct stones through the papilla: a single-center retrospective cohort study

2021 ◽  
Vol 49 (11) ◽  
pp. 030006052110583
Author(s):  
Songming Ding ◽  
Shanjie Dong ◽  
Hengkai Zhu ◽  
Weilin Wu ◽  
Yiting Hu ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Clinical Laboratory ◽  
Demographic Data ◽  
Gamma Glutamyl Transpeptidase ◽  
Stone Size ◽  
Cbd Stones ◽  
Spontaneous Passage ◽  
Group A ◽  
Group B

Objective Common bile duct (CBD) stones can spontaneously pass through the papilla. This study explored factors associated with stone passage by comparing differences in the clinical features of stones retained in the CBD and excreted stones. Methods Data were retrospectively collected for all patients who were hospitalized in our center between March 2016 and May 2021 with clinical, laboratory, or imaging evidence of CBD stones. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and were classified into two groups: group A (stones extracted by ERCP, n = 86) and group B (stones discharged before ERCP, n = 15). Demographic data, biochemical and radiological findings were compared between the groups. Results Stone size (0.82 vs. 0.33 cm), and levels of total bilirubin (58.2 vs. 28.8 μmol/L), gamma-glutamyl transpeptidase (416.7 vs. 193.9 U/L), alkaline phosphatase (191.9 vs. 123.1 U/L), carbohydrate antigen 19-9 (603.7 vs. 37.2 U/mL), and α-L-fucosidase (37.4 vs. 22.6 U/L) were significantly higher in group A than in group B. Logistic regression analyses showed that stone size was the only factor significantly associated with spontaneous passage of CBD stones. Conclusions CBD stones less than 0.33 cm in size may be self-expelled through the papilla.

scholarly journals Recurrent Cholangitis due to Hem-o-lok Clip Migration after Laparoscopic Common Bile Duct Exploration Treated with Endoscopic Retrograde Cholangiopancreatography

2021 ◽  
Vol 26 (3) ◽  
pp. 195-199
Author(s):  
Ji Woong Jang ◽  
Jae Hyuck Jun ◽  
Dong-kyu Lee ◽  
Hyeyoung Kim ◽  
Young Seok Doh ◽  
...  
Keyword(s):  
Foreign Body ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Epigastric Pain ◽  
Rare Complication ◽  
Common Bile Duct Exploration ◽  
Endoscopic Retrograde ◽  
Cbd Stones ◽  
Cbd Stone

Clip migration into the common bile duct (CBD) is a rare complication of laparoscopic biliary surgery. We report a case of Hem-o-lok clip migration-induced CBD stone in a 66-year-old man who underwent laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) 4 years ago. The patient visited the emergency room for upper abdominal pain. CT scan revealed increased CBD diameter and multiple CBD stones. We performed endoscopic retrograde cholangiopancreatography for CBD stone extraction. Cholangiography revealed multiple suspected filling defects in the CBD; stones and unknown foreign body were removed using Basket. The foreign body found in the duodenum was a Hem-o-lok clip. When epigastric pain develops in a patient who has undergone LC and LCBDE, it is possible that biliary stone occurs due to clip migration.

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