Skip to main content

Advertisement

SpringerLink
Log in

Factors predictive of the successful treatment of choledocholithiasis

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Choledocholithiasis is a common complication of cholelithiasis, occurring in up to 18% of patients. Multiple treatments are often performed during the course of the management of choledocholithiasis, sometimes without success. Our study was performed identify the factors predictive of the success of treatment with retrograde endoscopic cholangiopancreatography (ERCP).

Methods

This was a retrospective, case–control study that used data from a biliary disease database at Hospital de Clínicas de Porto Alegre (HCPA). Demographic, clinical, radiological and procedure-related variables were compared between patients with successful biliary clearance after one ERCP procedure (Group 1) and those with unsuccessful biliary clearance after one ERCP procedure (Group 2).

Results

Three hundred twenty patients were included in Group 1, while 254 were included in Group 2. Multivariate analysis showed that older age, previous biliary exploration, elevated serum total bilirubin, choledocholithiasis above the level of the confluence of the hepatic ducts, stones retained in the cystic duct or Mirizzi syndrome, dilatation of the bile duct diagnosed during ERCP, and the need for suprapapillary opening were independently associated with the failure of the first ERCP to achieve bile duct clearance. The performance of imaging at the same institution prior to the procedure and the retention of stones in the duodenal papilla were associated with the success of endoscopic treatment.

Conclusions

The variables identified in this study, when considered in conjunction with the results of previously published studies, can be used to guide the choice of therapeutic methods for patients with choledocholithiasis in the future, given the significant difference in outcomes between the two groups. In the future, a prospective study should be performed to determine whether the same factors are predictive of the success of other methods of treatment (surgical or percutaneous).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Manes G, Paspatis G, Aabakken L, Anderloni A, Arvanitakis M, Ah-Soune P, Barthet M, Domagk D, Dumonceau JM, Gigot JF, Hritz I, Karamanolis G, Laghi A, Mariani A, Paraskeva K, Pohl J, Ponchon T, Swahn F, Ter Steege RWF, Tringali A, Vezakis A, Williams EJ, van Hooft JE (2019) Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 51:472–491

    Article  Google Scholar 

  2. Ko CW, Lee SP (2002) Epidemiology and natural history of common bile duct stones and prediction of disease. Gastrointest Endosc 56:S165–S169

    Article  Google Scholar 

  3. Möller M, Gustafsson U, Rasmussen F, Persson G, Thorell A (2014) Natural course vs interventions to clear common bile duct stones: data from the Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks). JAMA Surg 149:1008–1013

    Article  Google Scholar 

  4. Copelan A, Kapoor BS (2015) Choledocholithiasis: diagnosis and management. Tech Vasc Interv Radiol 18:244–255

    Article  Google Scholar 

  5. Molvar C, Glaenzer B (2016) Choledocholithiasis: evaluation, treatment, and outcomes. Semin Interv Radiol 33:268–276

    Article  Google Scholar 

  6. European Association for the Study of the Liver (EASL) (2016) EASL clinical practice guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol 65:146–181

    Article  Google Scholar 

  7. Gao YC, Chen J, Qin Q, Chen H, Wang W, Zhao J, Miao F, Shi X (2017) Efficacy and safety of laparoscopic bile duct exploration versus endoscopic sphincterotomy for concomitant gallstones and common bile duct stones: a meta-analysis of randomized controlled trials. Medicine (Baltim) 96:e7925

    Article  Google Scholar 

  8. Perissat J, Huibregtse K, Keane FBV, Russell RCG, Neoptolemos JP (1994) Management of bile duct stones in the era of laparoscopic cholecystectomy. Br J Surg 81:799–810

    Article  CAS  Google Scholar 

  9. Podda M, Polignano FM, Luhmann A, Wilson MS, Kulli C, Tait IS (2016) Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis. Surg Endosc 30:845–861

    Article  Google Scholar 

  10. Williams E, Beckingham I, El Sayed G, Gurusamy K, Sturgess R, Webster G, Young T (2017) Updated guideline on the management of common bile duct stones (CBDS). Gut 66:765–782

    Article  Google Scholar 

  11. Maple JT, Ben-Menachem T, Anderson MA, Appalaneni V, Banerjee S, Cash BD, Fisher L, Harrison ME, Fanelli RD, Fukami N, Ikenberry SO, Jain R, Khan K, Krinsky ML, Strohmeyer L, Dominitz JA (2010) The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc 71:1–9

    Article  Google Scholar 

  12. Schacher FC, Giongo SM, Teixeira FJP, Mattos ÂZ (2019) Endoscopic retrograde cholangiopancreatography versus surgery for choledocholithiasis—a meta-analysis. Ann Hepatol 18:595–600

    Article  Google Scholar 

  13. Ricci C, Pagano N, Taffurelli G, Pacilio CA, Migliori M, Bazzoli F, Casadei R, Minni F (2018) Comparison of efficacy and safety of 4 combinations of laparoscopic and intraoperative techniques for management of gallstone disease with biliary duct Calculi: a systematic review and network meta-analysis. JAMA Surg 153:e181167

    Article  Google Scholar 

  14. Poulose BK, Arbogast PG, Holzman MD (2006) National analysis of in-hospital resource utilization in choledocholithiasis management using propensity scores. Surg Endosc 20:186–190

    Article  CAS  Google Scholar 

  15. Enochsson L, Sharp N, Gimberg K, Sandblom G (2020) The location of bile duct stones may affect intra- and postoperative cholecystectomy outcome: a population-based registry study. Am J Surg 220:1038–1043

    Article  Google Scholar 

  16. Singh AN, Kilambi R (2018) Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with gallbladder stones with common bile duct stones: systematic review and meta-analysis of randomized trials with trial sequential analysis. Surg Endosc 32:3763–3776

    Article  Google Scholar 

  17. Barr LL, Frame BC, Coulanjon A (1999) Proposed criteria for preoperative endoscopic retrograde cholangiography in candidates for laparoscopic cholecystectomy. Surg Endosc 13:778–781

    Article  CAS  Google Scholar 

  18. Gillaspie DB, Davis KA, Schuster KM (2019) Total bilirubin trend as a predictor of common bile duct stones in acute cholecystitis and symptomatic cholelithiasis. Am J Surg 217:98–102

    Article  Google Scholar 

  19. Easler JJ, Sherman S (2015) Endoscopic retrograde cholangiopancreatography for the management of common bile duct stones and gallstone pancreatitis. Gastrointest Endosc Clin N Am 25:657–675

    Article  Google Scholar 

  20. Trieu J, Rogers H, Umar S, Samuel R, Abougergi M, Bazarbashi AN, Desai M, Peluso H, Kröner P, Khan A, Singh S, Bilal M, Berzin T (2020) Increased mortality and costs seen among patients requiring repeat ERCP within the first year. Gastrointest Endosc 91:AB356

    Article  Google Scholar 

  21. Mori T, Sugiyama M, Atomi Y (2006) Gallstone disease: management of intrahepatic stones. Best Pract Res Clin Gastroenterol 20:1117–1137

    Article  Google Scholar 

  22. Ilgit ET, Gürel K, Önal B (2002) Percutaneous management of bile duct stones. Eur J Radiol 43:237–245

    Article  Google Scholar 

  23. Ozcan N, Kahriman G, Mavili E (2011) Percutaneous transhepatic removal of bile duct stones: results of 261 patients. Cardiovasc Interv Radiol 35:621–627

    Article  Google Scholar 

  24. Ramchandani M, Pal P, Reddy DN (2017) Endoscopic management of acute cholangitis as a result of common bile duct stones. Dig Endosc 29(Suppl 2):78–87

    Article  Google Scholar 

  25. Tranter SE, Thompson MH (2003) Spontaneous passage of bile duct stones: frequency of occurrence and relation to clinical presentation. Ann R Coll Surg Engl 85:174–177

    Article  CAS  Google Scholar 

  26. Lefemine V, Morgan RJ (2011) Spontaneous passage of common bile duct stones in jaundiced patients. Hepatobiliary Pancreat Dis Int 10:209–213

    Article  Google Scholar 

  27. Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, Moore JP, Fennerty MB, Ryan ME, Shaw MJ, Lande JD, Pheley AM (1996) Complications of endoscopic biliary sphincterotomy. N Engl J Med 335:909–918

    Article  CAS  Google Scholar 

  28. Andriulli A, Loperfido S, Napolitano G, Niro G, Valvano MR, Spirito F, Pilotto A, Forlano R (2007) Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 102:1781–1788

    Article  Google Scholar 

  29. Vezakis A, Fragulidis G, Polydorou A (2015) Endoscopic retrograde cholangiopancreatography-related perforations: diagnosis and management. World J Gastrointest Endosc 7:1135–1141

    Article  Google Scholar 

  30. Mariani A, Segato S, Anderloni A, Cengia G, Parravicini M, Staiano T, Tontini GE, Lochis D, Cantù P, Manfredi G, Amato A, Bargiggia S, Bernasconi G, Lella F, Canani MB, Beretta P, Ferraris L, Signorelli S, Pantaleo G, Manes G, Testoni PA (2019) Prospective evaluation of ERCP performance in an Italian regional database study. Dig Liver Dis 51(7):978–984

    Article  Google Scholar 

  31. de Araujo TB, Jotz GP, Zaki CH, Mantelli RA, Fernandes VF, Pretto GG, Volkweis BS, Corso CO, Cavazzola LT (2020) Intraoperative cholangiography with filling defects: comparative complication analysis of postoperative transcystic duct (TCD) catheter maintenance. Surg Endosc. https://doi.org/10.1007/s00464-020-08133-y

    Article  PubMed  Google Scholar 

  32. Almadi MA, Eltayeb M, Thaniah S, Alrashed F, Aljebreen MA, Alharbi OR, Azzam N, Aljebreen AM (2019) Predictors of failure of endoscopic retrograde cholangiography in clearing bile duct stone on the initial procedure. Saudi J Gastroenterol 25:132–138

    Article  Google Scholar 

  33. Üsküdar O, Parlak E, Dışıbeyaz S, Köksal AS, Cıçek B, Kılıç ZM, Ödemiş B, Şaşmaz N (2013) Major predictors for difficult common bile duct stone. Turk J Gastroenterol 24:423–429

    Article  Google Scholar 

  34. Kim HJ, Choi HS, Park JH, Park DI, Cho YK, Sohn CI, Jeon WK, Kim BI, Choi SH (2007) Factors influencing the technical difficulty of endoscopic clearance of bile duct stones. Gastrointest Endosc 66:1154–1160

    Article  Google Scholar 

  35. Frazee R, Regner J, Truitt MS, Agrawal V, Swope M, Burlew CC, Dissanaike S, Vangipurum D, Bruns B, O’Meara L, Stivers J, Kwok A, Grover BT, Kothari SN, Cibari C, Dunn J, McIntyre RC Jr, Wright F, Scherer EP, Crane C, Schroeppel TJ, Callaghan E, Gordy S, Todd R (2019) The southwestern surgical congress multi-center trial on suspected common duct stones. Am J Surg 217:1006–1009

    Article  Google Scholar 

  36. Kummerow KL, Shelton J, Phillips S, Holzman MD, Nealon W, Beck W, Sharp K, Poulose BK (2012) Predicting complicated choledocholithiasis. J Surg Res 177:70–74

    Article  Google Scholar 

  37. McHenry L, Lehman G (2006) Difficult bile duct stones. Curr Treat Options Gastroenterol 9:123–132

    Article  Google Scholar 

Download references

Funding

There was no funding for this study.

Author information

Authors and Affiliations

  1. Surgical Post-Graduate Program, Universidade Federal do Rio Grande do Sul, 2400 Ramiro Barcelos Street, Porto Alegre, 90035-002, Brazil

    Luciano Paludo Marcelino & Alessandro Bersch Osvaldt

  2. Department of Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil

    Luciano Paludo Marcelino, Tatiana Falcão Eyff, Vivian Pierre Bersch & Alessandro Bersch Osvaldt

  3. Universidade Luterana do Brasil Medical School, Canoas, Brazil

    Stefano Thofehrn

Authors
  1. Luciano Paludo Marcelino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefano Thofehrn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tatiana Falcão Eyff
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vivian Pierre Bersch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alessandro Bersch Osvaldt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luciano Paludo Marcelino.

Ethics declarations

Disclosures

Drs. Luciano Paludo Marcelino, Stefano Thofehrn, Tatiana Falcão Eyff, Vivian Pierre Bersch and Alessandro Bersch Osvaldt have no conflict of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Marcelino, L.P., Thofehrn, S., Eyff, T.F. et al. Factors predictive of the successful treatment of choledocholithiasis. Surg Endosc 36, 1838–1846 (2022). https://doi.org/10.1007/s00464-021-08463-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-021-08463-5

Keywords

Search

Navigation