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Unnecessary endoscopic retrograde cholangiopancreatography associated with the spontaneous passage of common bile duct stones into the duodenum: a multicenter retrospective study

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Abstract

Background

Unnecessary endoscopic retrograde cholangiopancreatography (ERCP) after spontaneous passage of common bile duct stones (CBDSs) should be avoided. This study aimed to examine the cumulative diagnosis rate and the predictive factors of spontaneous CBDS passage during the interval between the imaging diagnosis and ERCP.

Methods

This multicenter retrospective study included 1260 consecutive patients with native papilla diagnosed with CBDSs using imaging modalities. Predictive factors and cumulative diagnosis rate of spontaneously passed CBDSs during the interval between imaging diagnosis and ERCP were analyzed.

Results

The overall cumulative diagnosis rate of spontaneous CBDS passage was 6.2% (78/1260) during a mean interval of 5.0 days. In the multivariate analysis, CBDS sized < 6 mm on diagnostic imaging, solitary CBDS on diagnostic imaging, intervals between the imaging diagnosis and ERCP, and nondilated common bile duct (< 10 mm) were the significant factors associated with spontaneous CBDS passage. Specifically, the cumulative diagnosis rate of spontaneous passage was significantly higher in patients with solitary and CBDSs sized < 6 mm than in those with other CBDSs (14.4% [54/376] vs. 2.7% [24/884], P < 0.001). In both the asymptomatic and symptomatic groups, the cumulative diagnosis rate of the spontaneous passage of CBDSs was significantly higher in patients with solitary and CBDSs sized < 6 mm on diagnostic imaging than in those with multiple and/or CBDSs sized ≥ 6 mm on diagnostic imaging during a mean interval of 20.5 and 2.4 days, respectively (asymptomatic group: 22.4% [15/67] vs. 3.5% [4/113], P < 0.001, symptomatic group: 12.6% [39/309] vs. 2.6% [20/771], P < 0.001).

Conclusions

Solitary and CBDSs sized < 6 mm on diagnostic imaging can often lead unnecessary ERCP due to spontaneous passage. Preliminary endoscopic ultrasonography immediately before ERCP is recommended, especially in patients with solitary and small CBDSs on diagnostic imaging.

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Acknowledgements

We would like to thank the staff involved in ERCP at the participating institutions.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Kumamoto City Hospital, 4-1-60, Higashimachi, Higashi-Ku, Kumamoto, 862-8505, Japan

    Hirokazu Saito & Shuji Tada

  2. Department of Gastroenterology, Kumamoto Chuo Hospital, 1-5-1, Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan

    Hajime Iwasaki, Takashi Shono & Ikuo Matsushita

  3. Department of Gastroenterology, Saiseikai Kumamoto Hospital, 5-3-1, Chikami, Minami-Ku, Kumamoto, 861-4193, Japan

    Hisashi Itoshima, Kentaro Kamikawa, Masayoshi Uehara & Atsushi Urata

  4. Department of Gastroenterology, Tsuruta Hospital, 10-112, Hotakubohonmachi, Higashi-Ku, Kumamoto, 862-0925, Japan

    Yoshihiro Kadono

  5. Department of Gastroenterological Surgery, Kumamoto Chuo Hospital, 1-5-1, Tainoshima, Minami-Ku, Kumamoto, 862-0965, Japan

    Jiro Nasu

  6. Department of Biostatics Center, Medical School, Kurume University, 67, Asahimachi, Fukuoka, Kurume, 830-0011, Japan

    Tatsuyuki Kakuma

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  1. Hirokazu Saito
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Correspondence to Hirokazu Saito.

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Drs. Hirokazu Saito, Yoshihiro Kadono, Takashi Shono, Kentaro Kamikawa, Atsushi Urata, Jiro Nasu, Haruo Imamura, Ikuo Matsushita, Tatsuyuki Kakuma, and Shuji Tada have no conflicts of interest or financial ties to disclose.

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Saito, H., Iwasaki, H., Itoshima, H. et al. Unnecessary endoscopic retrograde cholangiopancreatography associated with the spontaneous passage of common bile duct stones into the duodenum: a multicenter retrospective study. Surg Endosc 37, 4585–4593 (2023). https://doi.org/10.1007/s00464-023-09954-3

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