Introduction

Common bile duct (CBD) stones can spontaneously migrate through the duodenal papilla. In this case, ERCP may be unnecessary and a significant rate of complications may be avoided..

Aims & Methods

Aims: The aim of our study is to evaluate the factors associated with spontaneous migration of CBD stones.
Methods:This is a retrospective descriptive and analytical study including 547 patients who underwent ERCP for CBD stones between January 2019 and September 2023.
All patients underwent MRCP for the diagnosis of CBD stones.
MRCP was considered positive if stones were present in CBD.
A positive ERCP was defined as the presence of stones in the VBP on cholangiography.
Patients were classified into 2 groups:
- Group A (n=309): positive MRCP and positive ERCP.
- Group B (n=265): positive MRCP but negative ERCP.
Statistical analysis was performed using JAMOVI software.

Results

The mean age in group A was 59.1 +/- 13.8 years and in group B 56.9 +/- 13.2 years, with no statistically significant difference (p=0.056).
The sex ratio (M/F) in group A was 0.7 and in group B 0.54, with a significant female predominance in both groups (p=0.03).
There was no statistically significant difference between the 2 groups in CBD diameter or presence of a periampullary diverticulum.
Comparing group A versus group B, patients with small stone diameter (P=0.001), a single stone (p=0,001) and distal stones (P=0.04) tended to pass their stones spontaneously.

Conclusion

In our study, the factors associated with spontaneous migration of CBD stones were a small stone diameter, a single stone and distal stones.

Introduction

Endoscopic retrograde cholangiopancreatography (ERCP) is now the gold standard for the treatment of bile duct stones. However, recurrence stones is frequent after their complete removal by endoscopic treatment.

Aims & Methods

The present study is retrospective, descriptive and analytic, including all patients who underwent ERCP for common bile duct (CBD) stones between January 2008 and January 2024.
Recurrent CBD stone was defined as the finding of a stone at least 6 months after the initial ERCP in which complete stone extraction was performed.
Factors associated with recurrent CBD stones were studied by logistic regression analysis.
Statistical analysis was performed using Jamovi software.
The aim of our study is to identify predictors of recurrent CBD stones after ERCP.

Results

Among 1151 patients who underwent ERCP for lithiasis pathology, 88 patients or 7.7% had recurrent CBD stone.
Mean age of the patients was 64.5 +/-13.4 years, with extremes ranging from 22 to 94 years. Sex ratio (M/F) was 0.69, with a female predominance of 59.1%.
20.5% of patients presented with acute angiocholitis and 6.8% with acute pancreatitis.
A periampullary diverticulum was found in 5.7% of patients (n=5).
In univariate analysis, the risk factors for recurrent CBD stone were: older age (OR :37; IC95% : [10,7- 127,2] ; p<0,001), female gender ( OR :9,9 ;IC95% : [4,49-22,04] ; p<0,001), CBD diameter > 15 mm (OR : 7,36 ;IC95% : [5,51-9,8] ; p<0,001), presence of angiocholitis ( OR : 2.06 ;IC95% : [1,12-3,8] ; p=0,02), number of CBD stones (OR :8,61; IC95% : [6,51-11,39] ; p=0,018), size of CBD stones (OR :2,51 ;IC95% : [1,43-4,39] ; p=0,001), while enlargement EST (OR :0,18; IC95% : [0,08-0,44] ; p<0,001) was a protective factor.
After multivariate analysis, and adjusting for the factors studied, only older age (OR:1.96; CI95%: [1.94-2.93]; p=0.001), number of CBD stones (OR: 1.99; CI95%: [1,2-3,4] ; p=0,037) and size of CBD stones (OR :4,06; IC95% : [3,51-6,72] ; p=0,003) were risk factors, and enlargement EST (OR :0,31; IC95% : [0,11-0,85] ; p=0,024) was protective factor.

Conclusion

In our study, the predictive factors for recurrent CBD stones were advanced age, the presence of impaction and a large stone.

Introduction

ERCP is the first-line procedure for the treatment of choledocholithiasis. Spontaneous migration of common bile duct (CBD) stones through the duodenal papilla is a phenomenon observed in some cases. This migration can render ERCP unnecessary and potentially avoid complications.

The objective of our study is to evaluate the factors associated with the spontaneous migration of CBD stones.

Aims & Methods

This is a retrospective descriptive and analytical study including 547 patients who underwent ERCP for CBD lithiasis between January 2020 and January 2025.
All patients underwent MRCP for the diagnosis of CBD lithiasis.
A positive MRCP was defined as the presence of stones in the CBD.
A positive ERCP was defined as the presence of stones in the CBD at cholangiography.
We divided the patients into 2 groups:

• Group A (n=309): MRCP + and ERCP +
• Group B (n=265): MRCP + and ERCP –

Results

The mean age in Group A was 59.1 +/- 13.8 years and in Group B was 56.9 +/- 13.2 years, with no statistically significant difference (p=0.056).
The sex ratio (M/F) in Group A was 0.7 and in Group B was 0.54, with a significant female predominance in both groups (p=0.03).
There was no statistically significant difference regarding the CBD diameter and the presence of a periampullary diverticulum between the two groups.
When comparing Groups A and B, patients with a small stone diameter (P=0.001), a single stone (p=<0.001), and distal stones (P=0.04) tended to spontaneously evacuate their stones.

Conclusion

In our study, the factors associated with the spontaneous migration of CBD stones are a small stone diameter, a single stone, and distal stone location.

Introduction

Evaluate the predictive factors of failure rate of clearing the biliary system from stones at the initial ERCP.

Aims & Methods

This is a retrospective descriptive and analytical study from September 2004 to September 2023.
All patients with bile duct stones, who underwent ERCP with endoscopic sphincterotomy and stone extraction by standard techniques (extraction balloon or Dormia basket) were included in this study.

Results

A total of 1080 ERCPs were performed to extract biliary duct stones .

The mean age was 58.9 +/- 14.4 years and 59.5% were females.
The mean diameter ofthe Bile duct was 13.4+/- 4.31 mm. The presence of a biliary stricture in 6.3%.
The primary vacuity rate was 75.1%. Supplementary techniques were used in 22.7% of cases.
On univariate analysis, the predictive factors for failure after use of standard techniques were: age(OR: 0.9;CI95%:-0.03- -0.01;p<0.001); gender(OR:0.7;CI95%:-0.5--0.02;p=0.036); previous cholecystectomy (OR:1.3,CI95%:0.02-0.6;p=0.035);presence of angiocholitis(OR: 0.4; CI95%:-1.1- -0.4;p<0.001); dilatation of the CBD >15mm (OR:0,8,CI95%:-0.2-0.1;p<0.001), biliary stricture (OR:0.3;CI95%:-1.7--0.7;p<0.001) and the presence of impacted and/or large stone (OR:0.1;CI95%:-2--1;p<0.001).
On multivariateanalysis, only the presence of angiocholitis (OR:1.9;CI95%: 0.2-1;p=0.001),impacted and/or large stone (OR:2.5;CI95%:0.5-1.3;p<0.001), dilatation ofthe CBD >15mm (OR:0.88;CI95%:-0.17- -0.07;p<0.001), and biliary stricture(OR:2.9;CI95%:0.4-1.7;p=0.002) were significantly associated with failure ofthe primary CBD vacuity rate.
The overall vacuity rate after using the supplementary techniques was 92.4%.

Conclusion

In our study, predictivefactors for failure of the primary CBD vacuity rate were the presence ofangiocholitis, impacted and/or large stone, dilatation of the CBD (>15mm)and biliary stricture.

Introduction

Endoscopic biliary sphincterotomy is an effective treatment for common bile duct stones. However, its success can be compromised by the presence of large stones or extensive choledochal lithiasis.
The aim of this study was to evaluate the effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) in patients with large obstructive stones (>15 mm) and those with one or two stones or choledochal lithiasis, and to identify factors influencing the success of endoscopic drainage and associated complications in the management of large bile duct stones.

Aims & Methods

This was a retrospective, descriptive, and analytical study conducted over a 19-year period, from April 2006 to February 2025, in our department.
A total of 1,011 patients who underwent ERCP for common bile duct stones were included. Choledochal lithiasis was defined as the presence of more than three stones, and a large stone was defined as an obstructive stone larger than 15 mm. Patients were divided into two groups:

• Group I (n = 143): Patients with a single obstructive stone larger than 15 mm.
• Group II (n = 868): Patients with one or two stones or choledochal lithiasis.

Results

Patients with large stones (Group I) represented 14.1% (n = 143) of the cohort, while Group II included 868 patients (85.9%).
The success rate after a single catheterization was 55.2% in Group I compared to 81% in Group II (p < 0.001). Reintervention was required in 14.7% of Group I patients versus 8% in Group II (p = 0.009). Additional procedures were performed in 46.2% of cases in Group I versus 16.1% in Group II.
The overall success rate after reintervention and/or additional procedures was 88.7% in Group I versus 92.5% in Group II (p = 0.125).
Early complication rates were higher in Group I (10.5%) compared to Group II (5.1%), with a statistically significant difference between groups (p = 0.017).
Univariate analysis identified the following factors as significantly decreasing the overall success rate of endoscopic treatment: older age, acute cholangitis, bile duct stricture, and significant bile duct dilation (diameter >15 mm).
Multivariate analysis, adjusted for age, sex, surgical history, acute pancreatitis, acute cholangitis, periampullary diverticulum, bile duct diameter, and bile duct stricture, showed that only acute cholangitis (OR: 0.295; 95% CI: [0.164 – 0.532]; p < 0.001) and bile duct stricture (OR: 0.53; 95% CI: [0.922 – 1.051]; p = 0.001) were independently associated with a decreased overall success rate of endoscopic treatment.

Conclusion

Our study found no statistically significant difference in the effectiveness of endoscopic treatment between patients with large stones and those with simple lithiasis. However, the presence of acute cholangitis and bile duct strictures appears to be associated with a reduced overall success rate of endoscopic management.

Introduction

Recurrence of common bile duct (CBD) stones after initial treatment is estimated to occur in 5%-20% of cases¹, requiring additional interventions and is associated with adverse patient outcomes. Previous small scale studies evaluated the role of UDCA in the prevention of CBD stone^2,3. We aimed to investigate whether UDCA is effective in preventing de-novo CBD stone formation.

Aims & Methods

This was a cohort analysis. We analyzed the electronic records of patients diagnosed with cholangitis or choledocholithiasis who underwent endoscopic retrograde cholangiopancreatography (ERCP) with evidence of complete common bile duct (CBD) stone removal. Due to the lack of consistent evidence, recommendations for using ursodeoxycholic acid (UDCA) to prevent stone recurrence varied among endoscopists. All patients were contacted and interviewed after providing informed consent. The follow-up period was defined as the time from the index ERCP to either evidence of CBD stone recurrence or the date of the patient interview. The primary outcome was a documented case of CBD stone recurrence. We compared baseline variables and outcomes between patients who were recommended to receive UDCA following ERCP and those who did not receive a UDCA recommendation. We performed univariate survival analysis using the log rank score to compare survival distributions between groups.

Results

Ninety-eight patients were included in the analysis and contacted. Of these, 50 patients received a recommendation for UDCA treatment, and 30 patients took UDCA. Additionally, 48 patients did not receive any recommendation for UDCA, contributing to a total of 68 patients who did not take UDCA. Comparison of baseline characteristics, index ERCP findings and outcomes between groups is presented in Table 1. There were no significant differences in patient ages and rate of major comorbidities. Most patients undergone cholecystectomy more than 24 months prior to the index ERCP. Previous sphincterectomy was more common in the UDCA treatment group (70% vs 17.6%; p<0.01). No marked differences were noted in regard to other index ERCP findings between the two groups including papillary anatomy, number, size, type of stones and technique of stone removal (Table 1). No significant difference in stone recurrence was between patients who took and did not take UDCA (recurrence in 8/30 patients [26.7%] and 22/68 [32.4%] respectively, P=0.75). There was no significant difference in survival without recurrence between the two groups (p=0.84).

Conclusion

Our findings do not suggest efficacy of UDCA in prevention of de-novo CBD stone recurrence after cholecystectomy and complete CBD clearance.

References

1. Lammert F, Acalovschi M, Ercolani G, et al. EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 2016;65(1):146-181. doi:10.1016/J.JHEP.2016.03.005
2. Yamamoto R, Tazuma S, Kanno K, et al. Ursodeoxycholic acid after bile duct stone removal and risk factors for recurrence: a randomized trial. J Hepatobiliary Pancreat Sci. 2016;23(2):132-136. doi:10.1002/jhbp.316
3. Swobodnik W, Janowitz P, Kratzer W, et al. [Preventing the recurrence of common bile duct calculi following endoscopic papillotomy with ursodeoxycholic acid]. Z Gastroenterol. 1990;28(11):621-625.

Disclosure

The authors report no conflict of interests

Introduction

Endoscopic retrograde cholangiopancreatography (ERCP) is now the gold standard for treating biliopancreatic conditions. With growing operator experience and significant advancements in endoscope and instrument design, outcomes have markedly improved. However, the procedure still carries a risk of complications and is not always successful in clearing bile duct stones on the first attempt. In this context, our study aims to evaluate the complication rate of ERCP in the management of common bile duct stones and to explore what factors predict failure to clear these stones during the initial procedure.

Aims & Methods

The aim of this study is to evaluate the predictive factors associated with failure of complete biliary stone clearance during the initial endoscopic retrograde cholangiopancreatography (ERCP) procedure. This is a retrospective, descriptive, and analytical study conducted over a 20-year period, from September 2005 to September 2025. It includes all patients with bile duct stones who underwent ERCP with endoscopic sphincterotomy, followed by stone extraction using standard techniques such as an extraction balloon or Dormia basket.

Results

A total of 1,080 ERCP procedures were performed for the extraction of bile duct stones. The mean age of the patients was 58.9 ± 14.4 years, with a female predominance (59.5%). The average diameter of the common bile duct (CBD) was 13.4 ± 4.31 mm, and biliary strictures were observed in 6.3% of cases. The primary duct clearance rate was 75.1%, while supplementary techniques were required in 22.7% of cases.
On univariate analysis, several factors were significantly associated with failure of stone clearance using standard techniques: younger age (OR: 0.9; 95% CI: -0.03 to -0.01; p < 0.001), male gender (OR: 0.7; 95% CI: -0.5 to -0.02; p = 0.036), history of cholecystectomy (OR: 1.3; 95% CI: 0.02 to 0.6; p = 0.035), presence of cholangitis (OR: 0.4; 95% CI: -1.1 to -0.4; p < 0.001), CBD dilation >15 mm (OR: 0.8; 95% CI: -0.2 to 0.1; p < 0.001), biliary stricture (OR: 0.3; 95% CI: -1.7 to -0.7; p < 0.001), and presence of impacted and/or large stones (OR: 0.1; 95% CI: -2 to -1; p < 0.001).
Multivariate analysis identified four independent predictors of primary clearance failure: presence of cholangitis (OR: 1.9; 95% CI: 0.2 to 1; p = 0.001), impacted and/or large stones (OR: 2.5; 95% CI: 0.5 to 1.3; p < 0.001), CBD dilation >15 mm (OR: 0.88; 95% CI: -0.17 to -0.07; p < 0.001), and biliary stricture (OR: 2.9; 95% CI: 0.4 to 1.7; p = 0.002).
Following the application of supplementary techniques, the overall bile duct clearance rate increased to 92.4%.

Conclusion

In our study, the main predictors of failure to achieve primary common bile duct clearance were cholangitis, the presence of impacted and/or large stones, CBD dilation greater than 15 mm, and biliary strictures.