Multidisciplinary management of Common Bile Duct Stones: A single centre experience of 844 patients over a five and a half year period

Abstract

Introduction: CBD stone diagnosis and management has deeply changed during the last 30 years, with the inclusion of imaging, like endoscopic ultrasound and magnetic resonance cholangiography endoscopy and laparoscopy. We present our data on the contemporary management of CBD stones. Method: A retrospective study of case records of all patients treated for common bile duct stones from jan 2012 to jun 2017 at our institute was undertaken. Various methods of treatment, both endoscopic and surgical and their complications were detailed. Result: 844 patients treated for CBD stones in a period of 66 months. 418 patients were males and 426 were females. The median age was 56yrs(6-94 yrs). EUS was performed on all patients.Our data showed sensitivity(95.75%) and PPV (95.27%) of EUS over MRI(Sensitivity 93.5%, PPV 95.08%).This was followed by therapeutic ERCP on the same day if EUS was positive for stones. Only sick patients with cholangitis underwent ERCP drainage as primary procedure. Of the 1592 ERCPs performed, 889 were performed for CBD stones. Our Success rate was 89.7%. Surgical Intervention was required in 532 cases. In 386 patients, laparoscopic cholecystectomy was performed within 48 hrs of the ERCP and were discharged home with 3-5 days of hospital stay.There were 35 interval cholecystectomies, 67 laparoscopic CBD explorations and 25 open explorations. Surgical complications were minimal- 3 patients having collection in GB fossa, 1 with port site abscess. Conclusion: This combined use of EUS, ERCP and Laparoscopy results in excellent success rates of common bile duct clearance and near zero mortality over a large series of cases.