Clinical characteristics, treatments, and outcomes of difficult biliary stones in a reference hospital in Colombia
DOI:
https://doi.org/10.47892/rgp.2023.432.1446Keywords:
Gallstones, Lithotripsy, Lithotripsy laser, Biliary Tract Surgical Procedures, difficult bile stoneAbstract
The local experience and the success rate of different available treatments for difficult biliary stones in Colombia are poorly described. We made an observational study reporting patients treated for difficult biliary stones, at Hospital Universitario San Ignacio in Bogotá, Colombia between January 2015, and November 2021. Clinical characteristics, endoscopic retrograde cholangiopancreatography (ERCP) findings, and outcomes are presented. Additionally, the success rates of Endoscopic Sphincterotomy Plus Large Balloon Dilation (ESLBD), Mechanical Lithotripsy (ML), temporary stenting (TS), cholangioscopy-guided laser lithotripsy (CGLL), and surgery are described. A total of 146 patients were included (median age 69 years, IQR 58.5-78.5, 33.8% men). The median stone diameter was 15 mm (IQR 10 – 18 mm). One stone was presented in 39.9%, two stones in 18.2%, and ≥3 stones in the remaining stone. A 67.6% disproportion rate was observed between the stone and distal common bile duct. Successful stone extraction was achieved in 56.2% in the first procedure, 22.6% in the second, 17.1% in the third, 3.4% in the fourth, and 0.7% in the fifth procedures. The successful extraction rates were 56.8% for ESLBD, 75% for ML, 23.4% for TS, 57.7% for CGLL, and 100% for surgery. Endoscopic management of difficult stones is usually successful, although it usually requires 2 or more ERCPs procedures. The surgical requirements were low. ESLBD is an effective technique unlike TS. Few patients required advanced techniques such as ML or CGLL. Endoscopic procedures are associated with a low rate of complications.
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Manes G, Paspatis G, Aabakken L, et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2019;51(5):472-491. doi:10.1055/a-0862-0346
Buxbaum JL, Abbas Fehmi SM, Sultan S, et al. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc. 2019;89(6):1075-1105.e15. doi:10.1016/j.gie.2018.10.001
McHenry L, Lehman G. Difficult bile duct stones. Curr Treat Options Gastroenterol. 2006;9(2):123-132. doi:10.1007/s11938-006-0031-6
Pereira Lima JC, Arciniegas Sanmartin ID, Latrônico Palma B, Oliveira Dos Santos CE. Risk Factors for Success, Complications, and Death after Endoscopic Sphincterotomy for Bile Duct Stones: A 17-Year Experience with 2,137 Cases. Dig Dis. 2020;38(6):534-541. doi:10.1159/000507321
Pereira Lima JC, Arciniegas Sanmartin ID, de Quadros Onófrio F, et al. Endoscopic Biliary Large Balloon Dilation Lithotripsy for Giant and Impacted Stones Removal: A Western Series. Dig Dis. 2021;39(4):391-398. doi:10.1159/000511766
Franzini T, Moura RN, Bonifácio P, et al. Complex biliary stones management: cholangioscopy versus papillary large balloon dilation - a randomized controlled trial. Endosc Int open. 2018;6(2):E131-E138. doi:10.1055/s-0043-122493
Liu P, Lin H, Chen Y, Wu YS, Tang M, Lai L. Comparison of endoscopic papillary large balloon dilation with and without a prior endoscopic sphincterotomy for the treatment of patients with large and/or multiple common bile duct stones: A systematic review and meta-analysis. Ther Clin Risk Manag. 2019;15:91-101. doi:10.2147/TCRM.S182615
Xu L, Kyaw MH, Tse YK, Lau JYW. Endoscopic sphincterotomy with large balloon dilation versus endoscopic sphincterotomy for bile duct stones: A systematic review and meta-analysis. Biomed Res Int. 2015;2015. doi:10.1155/2015/673103
Chang W-H, Chu C-H, Wang T-E, Chen M-J, Lin C-C. Outcome of simple use of mechanical lithotripsy of difficult common bile duct stones. World J Gastroenterol. 2005;11(4):593-596. doi:10.3748/wjg.v11.i4.593
Lee SH, Park JK, Yoon WJ, et al. How to predict the outcome of endoscopic mechanical lithotripsy in patients with difficult bile duct stones? Scand J Gastroenterol. 2007;42(8):1006-1010. doi:10.1080/00365520701204253
Thomas M, Howell DA, Carr-Locke D, et al. Mechanical lithotripsy of pancreatic and biliary stones: complications and available treatment options collected from expert centers. Am J Gastroenterol. 2007;102(9):1896-1902. doi:10.1111/j.1572-0241.2007.01350.x
Horiuchi A, Nakayama Y, Kajiyama M, et al. Biliary stenting in the management of large or multiple common bile duct stones. Gastrointest Endosc. 2010;71(7):1200-1203.e2. doi:10.1016/j.gie.2009.12.055
Chan AC, Ng EK, Chung SC, et al. Common bile duct stones become smaller after endoscopic biliary stenting. Endoscopy. 1998;30(4):356-359. doi:10.1055/s-2007-1001282
Jain SK, Stein R, Bhuva M, Goldberg MJ. Pigtail stents: an alternative in the treatment of difficult bile duct stones. Gastrointest Endosc. 2000;52(4):490-493. doi:10.1067/mge.2000.108409
Katsinelos P, Kountouras J, Paroutoglou G, Chatzimavroudis G, Zavos C. Combination of endoprostheses and oral ursodeoxycholic acid or placebo in the treatment of difficult to extract common bile duct stones. Dig liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver. 2008;40(6):453-459. doi:10.1016/j.dld.2007.11.012
Seitz U, Bapaye A, Bohnacker S, Navarrete C, Maydeo A, Soehendra N. Advances in therapeutic endoscopic treatment of common bile duct stones. World J Surg. 1998;22(11):1133-1144. doi:10.1007/s002689900532
Maydeo AP, Rerknimitr R, Lau JY, et al. Cholangioscopy-guided lithotripsy for difficult bile duct stone clearance in a single session of ERCP: results from a large multinational registry demonstrate high success rates. Endoscopy. 2019;51(10):922-929. doi:10.1055/a-0942-9336
Dasari BVM, Tan CJ, Gurusamy KS, et al. Surgical versus endoscopic treatment of bile duct stones. Cochrane database Syst Rev. 2013;(9):CD003327. doi:10.1002/14651858.CD003327.pub3
Poulose BK, Arbogast PG, Holzman MD. National analysis of in-hospital resource utilization in choledocholithiasis management using propensity scores. Surg Endosc. 2006;20(2):186-190. doi:10.1007/s00464-005-0235-1
Binmoeller KF, Brückner M, Thonke F, Soehendra N. Treatment of difficult bile duct stones using mechanical, electrohydraulic and extracorporeal shock wave lithotripsy. Endoscopy. 1993;25(3):201-206. doi:10.1055/s-2007-1010293
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