Sabbah Meriam, Nakhli Abdelwahab, Bellil Nawel, Ouakaa Asma, Bibani Norsaf, Trad Dorra, Elloumi Héla, Gargouri Dalila
Department of Gastroenterology, Habib Thameur Hospital, Tunisia.
Faculty of Medecine of Tunis, University of Tunis El Manar, Tunisia.
Heliyon. 2020 Nov 18;6(11):e05515. doi: 10.1016/j.heliyon.2020.e05515. eCollection 2020 Nov.
Endoscopic retrograde cholangiopancreatography associated with sphincterotomy and stone extraction with balloon or Dormia basket represents the gold standard for the management of common bile duct stones. The aim of our study were to investigate the predictors of failure of standard endoscopic techniques during the management of common bile duct stones.
A retrospective study including all endoscopic retrograde cholangiopancreatography for common bile duct stones between January 2014 and December 2017 was conducted. First line treatment was based on endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy and balloon or Dormia extraction. Second line endoscopic treatment was based on macrodilatation of Oddi sphincter, mechanical lithotripsy, biliary stent or nasobiliary drain placement. Predictors of failure of standard endoscopic techniques were sought by uni and multivariate analysis (SPSS software, p significant if < 0.05).
One hundred eighty one patients (mean age 64 years and sex ratio M/W = 0.4) were included. Main indications for endoscopic retrograde cholangiopancreatography were residual or recurrent lithiasis (67.4%, n = 122). Cholangiography revealed multiple stones in 53 patients with an average size of 12.5mm [3-40]. The success rate of first line treatment was 61.9%. Independent predictors of failure of standard endoscopic techniques (failure of papillary cannulation or stone extraction) according to multivariate analysis were: an age greater than 65 years OR 0.516 [0.272-0.979], an intra-diverticular papilla OR 0.179 [0.035-0.914], a common bile duct diameter greater than 15 mm OR 0.161 [0.068-0.385] and a stenosis of the common bile duct OR 0.068 [0.008-0.605]. The success rate of the second line treatment was 73%.
Endoscopic retrograde cholangiopancreatography results in a successful clearance of the common bile duct in almost two-thirds of patients. In case of predictors of failure, alternative techniques can increase this rate.
内镜逆行胰胆管造影术联合括约肌切开术以及使用球囊或多尔米亚网篮取石是胆总管结石治疗的金标准。我们研究的目的是调查胆总管结石治疗过程中标准内镜技术失败的预测因素。
进行一项回顾性研究，纳入2014年1月至2017年12月期间所有因胆总管结石而行内镜逆行胰胆管造影术的患者。一线治疗基于内镜逆行胰胆管造影术联合内镜括约肌切开术以及球囊或多尔米亚网篮取石。二线内镜治疗基于奥狄括约肌大口径扩张、机械碎石术、胆管支架置入或鼻胆管引流。通过单因素和多因素分析寻找标准内镜技术失败的预测因素（SPSS软件，p<0.05时有统计学意义）。
纳入181例患者（平均年龄64岁，男女比例M/W = 0.4）。内镜逆行胰胆管造影术的主要适应证为残留或复发性结石（67.4%，n = 122）。胆管造影显示53例患者有多个结石，平均大小为12.5mm[3 - 40]。一线治疗的成功率为61.9%。根据多因素分析，标准内镜技术失败（乳头插管或结石取出失败）的独立预测因素为：年龄大于65岁，OR 0.516[0.272 - 0.979]；憩室内乳头，OR 0.179[0.035 - 0.914]；胆总管直径大于15mm，OR 0.161[0.068 - 0.385]；胆总管狭窄，OR 0.068[0.008 - 0.605]。二线治疗的成功率为73%。
内镜逆行胰胆管造影术在近三分之二的患者中能成功清除胆总管结石。对于存在失败预测因素的情况，可采用替代技术提高成功率。
