Management of borderline common bile duct stones: Retrospective comparative study

Taha, Abdallah M.; Ahmed, Saada; Abdelhameid, Mahmoud; Maklad, Ahmad A.; Abozeid, Mahmoud A.; Abdelshafy, Mohamed

doi:10.4103/ejs.ejs_196_23

Management of borderline common bile duct stones: Retrospective comparative study

Authors

Abstract

Background
Borderline Size common bile duct stones (BLS-CBDS) are associated with hepato-pancreato-biliary morbidity and complications. Its optimum management is still controversial till now.
Aim
Is to compare conservative treatment versus endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of BLS-CBDS.
Material and methods
This retrospective study included patients with BLS-CBDS less than or equal to 10 mm who were treated conservatively or by ERCP endoscopic stone extraction followed by laparoscopic cholecystectomy (LC). The primary outcome was successful common bile duct (CBD) clearance, and the secondary outcomes were complications, impact on laparoscopic cholecystectomy, and hospital stay.
Results
Out of 270 patients, 150 were treated by ERCP and 120 by the Conservative approach. There was complete clearance of CBDS in 75 (50%) patients out of 150 patients in the ERCP group and useless procedure in the remaining 75 (50%) patients. In the conservative group, there was complete clearance of CBDS in 99 (82.5%) cases, and useless in the remaining 21 (17.5%) patients. Post-ERCP pancreatitis occurred in 33 (22%) patients.
Conclusion
BLS-CBDS increases the technical difficulty of ERCP and the risk of post-ERCP pancreatitis. Conservative management of CBDS is effective in clearing CBDS, it should be considered to avoid unnecessary ERCP and its complications.

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