Predictors of failure of endoscopic retrograde cholangiography in clearing bile duct stone on the initial procedure
Majid A Almadi1, Mohanned Eltayeb2, Salem Thaniah2, Faisal Alrashed3, Mohammad A Aljebreen3, Othman R Alharbi2, Nahla Azzam2, Abdulrahman M Aljebreen2
1 Gastroenterology Division, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Gastroenterology Division, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Canada
2 Gastroenterology Division, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
3 Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
Majid A Almadi,
Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh - 12372
Source of Support: None, Conflict of Interest: None
Background/Aims: The aim of this study is to predict cases where the clearance of the biliary system from stones at the initial endoscopic retrograde cholangiopancreatography (ERCP) might be of value for better risk-stratifying patients. We attempted to identify factors that are associated with a higher failure rate of clearing the biliary system on the index ERCP.
Patients and Methods: This is a retrospective study from January 2008 to January 2015. All patients with bile duct stones confirmed on ERCP were included in this study. Patients who had prior attempts of bile duct stone extraction were excluded.
Results: A total of 554 ERCPs were performed to extract biliary duct stones from 426 patients. The mean age was 46.3 years and 41.7% were males. The group where the index ERCP did not clear the biliary system tended to be older (50.4 vs. 45.2 years, P = 0.03). On multivariate analysis, the presence of fever (OR 4.64; 95% CI, 1.66–12.79), a larger number of filling defects (OR 1.34; 95% CI, 1.13–1.93), presence of a stricture distal to a stone (OR 4.63; 95% CI, 1.36–15.78), the use of an extraction basket (OR 3.23; 95% CI, 1.56–6.74), and/or mechanical lithotripsy (OR 3.05; 95% CI, 1.10–8.49) were all associated with a lower odds of clearing the biliary system. The use of an extraction balloon was associated with the success of clearing the biliary system (99.7% vs. 77.4%, P < 0.01) and a lower odds of failing (OR 0.01; 95% CI, 0.00–0.08) on multivariate analysis.
Conclusion: A few of the characteristics that are found on cholangiography at the index ERCP could be used to identify patients that might require more than one ERCP to clear the biliary system from stones.