Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", University of Medicine and Pharmacy, Cluj-Napoca, Romania.
J Gastrointestin Liver Dis. 2013 Jun;22(2):141-7.
BACKGROUND & AIMS: Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is the standard method of treatment for choledocholithiasis. We evaluated the diagnostic success rate and the outcomes of therapeutic ERCP for bile duct stones, in relation to the anatomical variants.
A total of 3,097 consecutive ERCPs were performed in 2,986 patients during a 10-year period (2002-2011) in our endoscopy department. The analysis of the results of therapy was performed in relation to the anatomical variants, patients' age, opacification of the Wirsung duct and recurrent lithiasis.
The rate of successful cannulation was 98%. The patient's age and the diameter of the common bile duct were the factors influencing the probability of finding a gallstone: age over 74 years, AUC=0.547 (p<0.001) and a CBD diameter larger than 12 mm (AUC=0.735, p<0.001). The number of cases with opacification of the Wirsung duct, the use of precut papillotomy and the inability of finding a stone significantly decreased with the increasing experience of the operator (p<0.001). The stone removal was unsuccessful in 2.3%. Factors associated independently with unsuccessful extraction were previous surgical sphincteroplasty, stone size and Billroth I anastomosis. Ninety two patients (4.3%) were diagnosed with recurrent lithiasis. Factors associated independently with recurrence were stone size (p=0.002, OR=0.35), dilation of infundibulum (p=0.04, OR=0.13) and the presence of periampullary diverticula (p=0.004, OR=0.28).
The endoscopic treatment of choledocholithiasis is highly effective. It is influenced partly by the experience of the operator. In experienced hands, the success rate is high even in cases of anatomical variants and difficult calculi.
经内镜逆行胰胆管造影术（ERCP）是治疗胆总管结石的标准方法。我们评估了与解剖变异相关的治疗性 ERCP 对胆管结石的诊断成功率和治疗结果。
在我们的内镜科，在 10 年期间（2002-2011 年）对 2986 例患者的 3097 例连续 ERCP 进行了分析。对治疗结果的分析与解剖变异、患者年龄、Wirsung 导管显影和复发性结石有关。
成功率为 98%。患者年龄和胆总管直径是影响发现胆囊结石概率的因素：年龄大于 74 岁，AUC=0.547（p<0.001）和胆总管直径大于 12mm（AUC=0.735，p<0.001）。Wirsung 导管显影的病例数、使用预切开乳头切开术和无法找到结石的情况随着术者经验的增加而显著减少（p<0.001）。结石清除术不成功的比例为 2.3%。与不成功提取相关的独立因素是先前的外科括约肌切开术、结石大小和 Billroth I 吻合术。92 例（4.3%）患者被诊断为复发性结石。与复发相关的独立因素是结石大小（p=0.002，OR=0.35）、壶腹扩张（p=0.04，OR=0.13）和壶腹周围憩室存在（p=0.004，OR=0.28）。
胆总管结石的内镜治疗非常有效。它部分受到术者经验的影响。在有经验的手中，即使在解剖变异和困难结石的情况下，成功率也很高。
