Endoscopic treatment of choledocholithiasis: effectiveness and complications

Abstract

Background and aim. The use of ERCP and related endoscopic interventions is a priority minimally invasive treatment of choledocholithiasis. The aim of this study is to analyze the results of endoscopic treatment of choledocholithiasis. Materials and methods. A retrospective analysis of the treatment of 336 patients with choledocholithiasis was performed. Results and Discussion. There were 117 men (34.8%) and 219 women (65.2%). The age of patients was from 21 to 91 years (64.1±14.3). Acute cholangitis was present in 28 (8.3%), acute biliary pancreatitis in 20 (5.9%), and in 5 (1.4%) cholangitis was combined with biliary pancreatitis. In general, the restoration of biliary outflow was achieved in 330 (98.2%) patients, complete removal of stones was performed in 314 (93.5%). A particularly difficult form of choledocholithiasis was Mirizzy syndrome with cholecystobiliary fistula – removal was performed only in 5 of 18 patients (χ2=101.289, p<0,0001). Complications after endoscopic interventions were in 19 (5,7%) patients: pancreatitis – 8 (2,4%), bleeding 6 (2%), perforation 2 (0.7%), acute cholecystitis 3 (1%). Out of 336 patients, 4 (1.2%) died from complications of biliary pancreatitis (1), cholangitis (1), myocardial infarction (1), and perforation after endoscopic interventions (1). Conclusions. Endoscopic interventions are an effective method of treating choledocholithiasis, and allow 98.2% of patients to restore bile flow, and 93.5% to completely remove stones. The most complicated form of choledocholithiasis for endoscopic treatment is Mirizi syndrome with cholecystobiliary fistula. The development of complications after endoscopic interventions, which occurred in 5.7% of patients, does not depend on the type of choledocholithiasis or the effectiveness of lithoextraction.