Abstract
Background and Aims: Introduction: Endoscopic Retrograde Cholangiopancreatography(ERCP) has become the first line treatment for patients with common bile duct (CBD) stones. This technique may fail, however, due to presence of a large stone, multiple stones, periampullary diverticula or CBD stricture. The aim of this study was to evaluate the success of CBD cannulation, Endoscopic Sphincterotomy(EST) and CBD clearance in initial attempt, identify the failures of stone extraction and assess the post-ERCP complications.
 Methods: A prospective study was carried out over the period of January 2019 to January 2020 on 100 consecutive patients with CBD stones. ERCP was done and the stone size and number recorded. EST was performed using a diathermy unit with a cutting current and stones were extracted using a Balloon catheter or a Dormia basket.
 Results: Of the 100 patients, 44 were male and 56 were female with mean age of 52}17years. Selective CBD cannulation and cholangiogram was achieved in 90%, EST was successful in 90% and complete stone clearance was achieved in first attempt in 46 patients (59%). 52 patients had difficult CBD stone. There were nine complications, most of which rapidly resolved on conservative treatment (four post-ERCP pancreatitis, three bleeding and one retroperitoneal perforation) and one mortality in an old lady due to PSVT that couldn’t be directly attributed to ERCP. Among patients with Stone less than 15 mm in diameter(n=58), stone was removed successfully in 45 patients(78%) whereas in patients with stones over 15 mm (n=20) only one was removed successfully (5%) at initial attempt. Of these 32 patients with residual stones, 13 were referred for surgery and 19 had insertion of biliary stent to be followed by repeat ERCP.
 Conclusion: Endoscopic therapy is a simple, effective and safe method of treatment in patients with CBD stone.
Highlights
Studies regarding the natural history of choledocholithiasis indicate that 21% to 34% common bile duct (CBD) stones will spontaneously migrate and migrating stones pose a moderate risk of pancreatitis (25% to 36%)[5, 6] or cholangitis if they obstruct the distal bile duct
In diverse settings, including community practice, reported success rates for removing CBD stones at ERCP have commonly ranged from 87% to 100%, with acceptably low rates of morbidity (~5%).[8, 9]
The diagnosis of CBD stone was based on history and imaging on USG or MRCP either depicting CBD stone or in association with dilated common bile duct and obstructive pattern in LFT
Summary
Cholelithiasis is an endemic condition in both Western and Eastern countries, affecting upto 20% of the general population.[1 11] to 21% of patients with cholelithiasis have concomitant common bile duct(CBD) stones.[2,3,4] Studies regarding the natural history of choledocholithiasis indicate that 21% to 34% CBD stones will spontaneously migrate and migrating stones pose a moderate risk of pancreatitis (25% to 36%)[5, 6] or cholangitis if they obstruct the distal bile duct. A widely used consensus definition for post-ERCP pancreatitis (PEP) is new or worsened abdominal pain, new or prolongation of hospitalization for at least 48hrs, and serum amylase ≥3 times the upper limit of normal, measured more than 24 hours after the procedure.[11] By using this definition, the incidence of PEP in a meta-analysis of 21 prospective studies was approximately 3.5%12 but ranges widely(1.6%-15.7%).[13] Hemorrhage is primarily a complication related to sphincterotomy. Introduction: Endoscopic Retrograde Cholangiopancreatography(ERCP) has become the first line treatment for patients with common bile duct (CBD) stones. This technique may fail, due to presence of a large stone, multiple stones, periampullary diverticula or CBD stricture. The aim of this study was to evaluate the success of CBD cannulation, Endoscopic Sphincterotomy(EST) and CBD clearance in initial attempt, identify the failures of stone extraction and assess the post-ERCP complications
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