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ORIGINAL ARTICLE
Year : 2017  |  Volume : 2  |  Issue : 1  |  Page : 18-22

Endoscopic management of multiple and large choledochal stones: success and complication rates and associated factors


1 Gastroenterology II department, Mohamed V military teaching hospital, Mohamed V-Souissi University, Rabat, Morocco
2 Gastroenterology unit, 5th Military hospital of Guelmim, Morocco

Correspondence Address:
Tarik Adioui
Gastroenterology II department, Mohamed V military teaching hospital, Mohamed V-Souissi University, Rabat
Morocco
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Source of Support: None, Conflict of Interest: None


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Background: Residual lithiasis of common bile duct is an indication of choice for endoscopic sphincterotomy. Endoscopic treatment provides clearance of the common bile duct in 90% of cases. However, the presence of multiple or large stones may limit its results. The aim of this study is to evaluate success rate, associated factors and complications of endoscopic treatment in this condition. Material and methods: A total of 542 patients who had undergone endoscopic retrograde cholangiopancreatography for common bile duct stones from January 2007 to March 2013 were retrospectively studied. We compared the results and complications in patients with multiple and/or large stones (group I) versus patients with simple choledochal lithiasis (group II). Results: Patients with multiple and/or large stones represented 32.8% of all patients. The Success rate after first catheterization was 64% in group I versus 90.2% in group II (p<0,001). The overall success rate after additional maneuvers and/or re-intervention was 89% in group I versus 95.3% in group II (p = 0.006). The overall rate of early complications was 4.8% in group II versus 7.8% in group I (p = 0.37). In multivariate analysis, the presence of cholangitis, periampullary diverticulum and choledochal stenosis were associated with lower success rate of endoscopic treatment. Conclusion: Although multiple and large choledochal stones are a real problem for endoscopic management, additional maneuvers allowed us to increase the success rate with no significant rise in early complications. The presence of cholangitis, periampullary diverticulum and/or choledochal stenosis were associated with lower success rate of endoscopic treatment.


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