Factors Significantly Contributing to a Failed Conventional Endoscopic Stone Clearance in Patients with “Difficult” Choledecholithiasis: A Single-Center Experience

The objective of this study is to retrospectively evaluate factors significantly contributing to a failed stone extraction (SE) in patients with difficult to extract bile duct stones (BDS). Patients and Methods. During a 10-year period 1390 patients with BDS underwent successfully endoscopic sphincterotomy. Endoscopic SE was graded as easy; relatively easy; difficult; and failed. Difficult SE was encountered in 221 patients while failed SE was encountered in 205. A retrospective analysis of the criteria governing the difficulty of endoscopic SE following the index endoscopic intervention was performed to evaluate their significance in determining failure of complete SE among patients with difficult to extract bile duct stones. Results. Age ≥ 85 years, periampullary diverticula, multiple CBD stones (>4), and diameter of CBD stones (≥15 mm) were all significant contributing factors to a failed SE in univariate statistical tests. In the definitive multivariate analysis age, multiple stones and diameter of stones were found to be the significant, independent contributors. Conclusion. Failed conventional endoscopic stone clearance in patients with difficult to extract BDS is more likely to occur in overage patients, in patients with multiple CBD stones >4, and in patients with CBD stone(s) diameter ≥15 mm.

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Post-ERCP Dormia basket impaction: a case report and literature review

International Surgery Journal ◽

10.18203/2349-2902.isj20214765 ◽

2021 ◽

Vol 8 (12) ◽

pp. 3692

Author(s):

Alaaeldin Mohamed Sedik ◽

Abrar Hussein ◽

Abdelmajid Alshimary ◽

Mostafa Elsayed ◽

Ahmed Alzayed ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Bile Duct Stone ◽

Common Bile Duct Stones ◽

Bile Duct Stones ◽

Stone Extraction ◽

Endoscopic Retrograde ◽

Dormia Basket ◽

Life Threatening ◽

Cbd Stone

The incidence of Common bile duct stones (CBD) in patients undergoing cholecystectomy is 10%. The present-day management of common bile duct stone may be pre-, intra-, or post-operative Endoscopic retrograde cholangio-pancreatography (ERCP) with stone extraction. The reported complications of ERCP and CBD stone extraction range from 5 to 10% cases, that might be life threatening. Herein, we reported a case of calculus obstructive jaundice and cholangitis. Unfortunately, trials for ERCP and stone retrieval was followed by impacted Dormia basket which was successfully managed by surgerys.

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Risk Factors for Recurrence of Symptomatic Common Bile Duct Stones after Cholecystectomy

Gastroenterology Research and Practice ◽

10.1155/2012/417821 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 16

Author(s):

Ju Hyun Oak ◽

Chang Nyol Paik ◽

Woo Chul Chung ◽

Kang-Moon Lee ◽

Jin Mo Yang

Keyword(s):

Risk Factors ◽

Bile Duct ◽

Bile Duct Stones ◽

Cbd Stones ◽

Number Of Patients ◽

Periampullary Diverticulum ◽

Risk Factors For Recurrence ◽

The Mean ◽

Cbd Stone

Purpose. The recurrence of CBD stone is still observed in a considerable number of patients. The study was to evaluate the risk factors for recurrence of symptomatic CBD stone in patients who underwent cholecystectomy after the removal of CBD stone.Methods. The medical records of patients who underwent removal of CBD stone with subsequent cholecystectomy were reviewed. The risk factors for the recurrence of symptomatic CBD stone were compared between the recurrence and the nonrecurrence group.Results. The mean follow-up period was 40.6 months. The recurrence of symptomatic CBD stones was defined as the detection of bile duct stones no sooner than 6 months after complete clearance of CBD stones, based on symptoms or signs of biliary complication. 144 patients (68 males, 47.2%) were finally enrolled and their mean age was 59.8 (range: 26~86) years. The recurrence of CBD stone occurred in 15 patients (10.4%). The mean period until first recurrence was 25.9 months. The presence of type 1 or 2 periampullary diverticulum and multiple CBD stones were the independent risk factors.Conclusion. For the patients with type 1 or 2 periampullary diverticulum or multiple CBD stones, careful followup is needed for the risk in recurrence of symptomatic CBD stone.

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One-stage lapro-endoscopic procedure in the management of concomitant gallbladder and common bile duct stones: institutional experience

International Surgery Journal ◽

10.18203/2349-2902.isj20191864 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1447

Author(s):

Ahmed M. Abdelaziz Hassan ◽

Ayman M. Abdelaziz ◽

Mohamed Emad Esmat ◽

Hussam Hamdy ◽

Magdy M. Elsebae

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Gallstone Disease ◽

Operating Time ◽

Common Bile Duct Stones ◽

Biliary Duct ◽

Bile Duct Stones ◽

Stone Clearance ◽

One Stage ◽

Cbd Stone

Background: Still there is no standard technique for managing patients with concomitant gallbladder (GB) and common bile duct stones (CBDS). In this work, we report our experience of the management for gallstone disease and biliary duct calculi as a single stage treatment.Methods: Forty Patients with symptomatic gall bladder calcular disease and suspected CBDS were enrolled in the study. The outcome measures were operating time, CBD stone clearance, postoperative morbidity and mortality, the need to conversion to other techniques and hospital stay.Results: They were 13 males and 27 females of median age 43 years old. Intra opertative cholangiography (IOC) revealed single CBD stone in twenty-eight, two stones in eleven and three stones in only one of the patients. The mean operating time had been 175 min. There were no intraoperative complications with a mean hospital stay was 1.8 days (range, 1-4 days).Conclusions: One-stage lapro-endoscopic procedure in the management for gallstone disease and biliary duct calculi is safe and efficient in CBD stone clearance. It is preferred when facilities and experience in endoscopic therapy exist.

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LAPAROSCOPIC MANAGEMENT OF COMMON BILE DUCT STONES

10.36106/ijsr/7223545 ◽

2020 ◽

pp. 1-4

Author(s):

Binit Prasad ◽

Mukesh Kumar ◽

Debarshi Jana

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Open Surgery ◽

Common Bile Duct Stones ◽

Single Stage ◽

Bile Duct Stones ◽

Cbd Stones ◽

Cbd Stone ◽

Laparoscopic Cbd Exploration ◽

Cbd Exploration

Introduction: Common Bile Duct stones (CBD) are found in approximately 16% of the patients undergoing Laparoscopic cholecystectomy (LC). Till recently, the gold standard for treating CBD stones was endoscopic removal, if that failed, then open surgery. However, in the laparoscopic era, the best treatment for CBD stones is a matter of debate and it continues to evolve. The objective of the present study is to determine that laparoscopic CBD exploration (LCBDE) is a safe, feasible and single-stage option for the management of CBD stones. Materials and Methods :Out of the 2900 laparoscopic cholecystectomies we did selective intraoperative cholangiogram in 262 patients who were suspected to have CBD stones based on deranged liver function tests, dilated CBD with or without CBD stone on sonography or having the history of recent jaundice/pancreatitis. If CBD stone was found, either a transcystic or transcholedochal exploration was done depending on the size, site, number of stones and CBD diameter. Choledochotomy was closed over a t-tube in the majority of the patients. Primary closure of CBD was done in few patients and in one patient we placed an antegrade stent and in another we placed endoscopic stent into the CBD laparoscpically which was removed after four weeks. Results :Till date we have performed LCBDE in 64 patients. Transcystic exploration was done in 14 patients and transcholedochal exploration was done in 46 cases out of which 2 patients had minor biliary leak which settled on conservative treatment in 2-3 days. Four patients required conversion to open surgery as there were multiple stones. We did not have any major complication and on 6 months follow-up in 76% patients, none was found to have residual stone. Conclusion :The treatment of CBD stones depends on the resources available, technical limitations and the surgeon’s expertise. Laparoscopic CBD exploration is a safe, feasible and single-stage option for the management of CBD stones.

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Intelligent difficulty scoring and assistance system for endoscopic extraction of common bile duct stones based on deep learning: multicenter study

Endoscopy ◽

10.1055/a-1244-5698 ◽

2020 ◽

Author(s):

Li Huang ◽

Xiaoyan Lu ◽

Xu Huang ◽

Xiaoping Zou ◽

Lianlian Wu ◽

...

Keyword(s):

Deep Learning ◽

Bile Duct ◽

Common Bile Duct ◽

Balloon Dilation ◽

Technical Difficulty ◽

Assistance System ◽

Stone Clearance ◽

Cbd Stones ◽

Endoscopic Extraction ◽

Cbd Stone

Abstract Background The study aimed to construct an intelligent difficulty scoring and assistance system (DSAS) for endoscopic retrograde cholangiopancreatography (ERCP) treatment of common bile duct (CBD) stones. Methods 1954 cholangiograms were collected from three hospitals for training and testing the DSAS. The D-LinkNet34 and U-Net were adopted to segment the CBD, stones, and duodenoscope. Based on the segmentation results, the stone size, distal CBD diameter, distal CBD arm, and distal CBD angulation were estimated. The performance of segmentation and estimation was assessed by mean intersection over union (mIoU) and average relative error. A technical difficulty scoring scale, which was used for assessing the technical difficulty of CBD stone removal, was developed and validated. We also analyzed the relationship between scores evaluated by the DSAS and clinical indicators including stone clearance rate and need for endoscopic papillary large-balloon dilation (EPLBD) and lithotripsy. Results The mIoU values of the stone, CBD, and duodenoscope segmentation were 68.35 %, 86.42 %, and 95.85 %, respectively. The estimation performance of the DSAS was superior to nonexpert endoscopists. In addition, the technical difficulty scoring performance of the DSAS was more consistent with expert endoscopists than two nonexpert endoscopists. A DSAS assessment score ≥ 2 was correlated with lower stone clearance rates and more frequent EPLBD. Conclusions An intelligent DSAS based on deep learning was developed. The DSAS could assist endoscopists by automatically scoring the technical difficulty of CBD stone extraction, and guiding the choice of therapeutic approach and appropriate accessories during ERCP.

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Surgical management of the impacted dormia basket during ERCP

International Surgery Journal ◽

10.18203/2349-2902.isj20191908 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1783 ◽

Cited By ~ 1

Author(s):

Cherring Tandup ◽

Lileswar Kaman ◽

Saroj Kant Sinha

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Obstructive Jaundice ◽

Bile Duct Stone ◽

Common Bile Duct Stones ◽

Bile Duct Stones ◽

Stone Extraction ◽

Endoscopic Retrograde ◽

Dormia Basket ◽

Cbd Stone

The incidence of associated common bile duct stones in patients undergoing cholecystectomy is 10%. The present day management of common bile duct stone is pre- or post-operative endoscopic retrograde cholangio-pancreatography and clearance of common bile duct. Complications of ERCP and CBD stone extraction have been reported to occur in 5 to 10% cases which may range from mild to life threatenin Here we report a case of cholelithiasis with choledocholithiasis with obstructive jaundice and patient while undergoing ERCP and stone retrieval had complication of impacted dormia basket which was managed by surgery.

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