Ng Sze, How
(2008)
Outcome of endoscopic clearance of bile duct stones after endoscopic sphincterotomy (ES): Hospital Kota Bharu (HKB) experience.
Masters thesis, Universiti Sains Malaysia.
Abstract
Choledocholithiasis or common bile duct (CBD) stones are still
frequently encountered in cholecystectomy patients. The use of endoscopic retrograde
cholangiopancreaticography (ERCP) and endoscopic sphincterotomy (ES) in the
management of CBD stones has progressed tremendously. However, the controversy is
still present in Malaysia as its morbidity and morbidity can be significant. The present study is designed to assess the results of endoscopic
clearance of CBD stones after ES in relation to the number, location and size of the stone
with help of mechanical or electrohyraulic lithotripsy, Dormia basket and balloon
catheter. It is also to evaluate its complications. Retrospective case review of 111 patients with CBD stones who
had undergone ERCP from January 2003 to December 2005 in Hospital Kota Bharu
(HKB), Kelantan. Data of those patients who fulfilled the criteria were documented and
the clearance rate as well as the complications of the procedure were analysed using
SPSS software (version 11.0). ERCP with ES was attempted in 111 patients and stone clearance was
successful in 68 (61.3%) patients. 71 (64%) were female and 40 (36%) were male. The
median age of male was 54 years old and of female was 49 years old. Female patients
predominantly presented with smaller ( <1 0 mm), distally located and multiple stone.
There were 51 (63.8%), 40 (64.5%) and 50 (66.7%) female patients with smaller, distally
located and multiple CBD stones respectively. CBD stones which were <1 0 mm and
distally located had more successful clearance while the number of stone showed no
statistical difference. Complications occurred in 14 (12.6%) patients, bleeding in 4
(3.6%) patients, acute pancreatitis in 8 (7.5%) patients, sepsis or cholangitis as well as
perforation each in I (0.9%) patient and no death was reported. Lastly, 7 (6.3%) patients
needed surgical interventions and 2 of them had undergone emergency laparotomy for the
complication and 5 patients required CBD exploration after failure to retrieve the stone
byERCP.
CONCLUSIONS: This study suggested that ERCP with ES continue to play an
important and effective role in the management of CBD stones. Stone extraction by
ERCP and ES has been found to be effective, safe and easy to perform. More
importantly, it also has demonstrated that the smaller (<IOmm) and distally located
stones were easier to retrieve regardless of the number of stones in the CBD. Moreover,
an acceptable complication rate for endoscopic therapy of CBD stone in HKB was found
comparable to elsewhere in the world. However, more stringent criteria with larger
number of cases, review, and ongoing practice are needed to ensure optimal benefit to
patients in the future.
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