Choledocholithiasis: Long term follow up in patients without stone clearance at first ERCP

Kourounis, G. , Gall, L. S., Mcarthur, D., Gibson, S. and Glen, P. (2021) Choledocholithiasis: Long term follow up in patients without stone clearance at first ERCP. Journal of Digestive Diseases, 22(9), pp. 551-556. (doi: 10.1111/1751-2980.13043) (PMID:34405551)

Abstract

Objectives: Complete clearance during index ERCP for choledocholithiasis is not always successful and biliary stenting is commonplace. Strategies vary between temporary stent placement (TSP) with interval ERCP or permanent stent placement (PSP) and watchful waiting for recurrent biliary obstruction (RBO). This study aimed to describe outcomes between these groups, and stent patency rates in the PSP group. Methods: All patients with incomplete clearance at first ERCP for choledocholithiasis between May 2015 and December 2018 were identified from a prospectively collected single-centre database. Clinical outcomes were obtained by retrospective interrogation of case notes. Median follow-up was 41(IQR:29–51) months. Results: Of 1263 index ERCPs, 199(15.8%) concluded without stone clearance. All received biliary stenting, 106/199(53%) as PSP and 93/199(47%) with TSP. The TSP group had repeat ERCP after median 8(IQR:6–15) weeks; 70/93(75%) had clearance on repeat ERCP. Median age was greater in the PSP v TSP group (82 v 72 years, p < 0.05). Rates of RBO (32.1 v 16.1%, p < 0.05), and emergency readmissions (32.1 v 19.4%, p < 0.05) were greater in the PSP group. More patients died without further biliary disease in the PSP group (39.6 v 12.9%, p < 0.05). PSP stent patency rates at 6, 12, 24, 36, and 61 months were 87.7%, 82.1%, 75.5%, 69.8% and 67.9% respectively. Conclusions: Though PSP had higher RBO and emergency readmissions, 2/3 of these patients either died or survive without recurrent biliary disease. Stent patency decreased fastest in the first 12 months. Patient criteria to guide decision making regarding biliary stenting remain unclear.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Kourounis, Dr Georgios and Glen, Mr Paul and Gibson, Mr Simon
• Authors: Kourounis, G., Gall, L. S., Mcarthur, D., Gibson, S., and Glen, P.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Journal of Digestive Diseases
• Publisher: Wiley
• ISSN: 1751-2972
• ISSN (Online): 1751-2980
• Published Online: 18 August 2021
• Copyright Holders: Copyright © 2021 John Wiley & Sons, Ltd.
• First Published: First published in Journal of Digestive Diseases 22(9): 551-556
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher