Debora Ciprani, Hoda Amar, Majd Abusharar, Trisha Lopes, Rahi Karmarkar, Ahmed Almadi, Somaiah Aroori
Peninsula HPB Unit, University Hospitals Plymouth NHS Trust, Plymouth, PL6 8DH, England, UK.
Dig Dis Sci. 2025 Aug 29. doi: 10.1007/s10620-025-09333-z.
Endoscopic Retrograde Cholangiopancreatography (ERCP) is the standard treatment for bile duct stones (BDS). While reported success rates often exceed 80%, the literature rarely distinguishes between success at the index ERCP and cumulative success across multiple procedures. Moreover, definitions of ERCP success vary significantly.
This study evaluates the index ERCP's success rates according to pre-defined criteria.
A retrospective review of all ERCPs performed for BDS before cholecystectomy at University Hospitals Plymouth (2009-2023). Primary outcomes included bile duct clearance at index ERCP, post-procedural complications, stone recurrence, and mortality.
A total of 1,436 patients, median age 72 years (20-94), underwent 1853 ERCPs for BDS. The bile duct cannulation and clearance rates were 93.5% and 70.9%, respectively. The main reasons for procedure failure were incomplete stone removal (12.3%) and anatomical challenges (7.1%). Among the cohort, 22.8% required repeat ERCPs. The complication rate was 4.8% (pancreatitis = 1.7%, biliary sepsis = 1.5%, bleeding = 1.3% and perforation = 0.4%). The BDS recurrence rate was 9.8% and the median time to recurrence was 7 months (1-112). On multivariate analysis, male sex was the only risk factor for stone recurrence (OR:2.242,95%CI:1.304-3.853, P = 0.003). All patients with post-ERCP complications were admitted to the hospital, and their median hospital stay was seven days (1-306). The 90-day mortality rate was 2.1%.
In our study, index ERCP achieved stone clearance in 70.9% of cases, with a quarter of patients needing a repeat procedure. Patients should be appropriately consented to and informed of the success rate of ERCP and alternative treatment options, such as intraoperative imaging followed by bile duct exploration and cholecystectomy for surgically fit patients.
内镜逆行胰胆管造影术（ERCP）是胆管结石（BDS）的标准治疗方法。虽然报道的成功率通常超过80%，但文献中很少区分初次ERCP的成功率和多次手术的累积成功率。此外，ERCP成功的定义差异很大。
本研究根据预先定义的标准评估初次ERCP的成功率。
回顾性分析普利茅斯大学医院（2009 - 2023年）胆囊切除术前因BDS进行的所有ERCP。主要结局包括初次ERCP时胆管结石清除情况、术后并发症、结石复发和死亡率。
共有1436例患者，中位年龄72岁（20 - 94岁），因BDS接受了1853次ERCP。胆管插管率和结石清除率分别为93.5%和70.9%。手术失败的主要原因是结石清除不完全（12.3%）和解剖结构复杂（7.1%）。在该队列中，22.8%的患者需要重复ERCP。并发症发生率为4.8%（胰腺炎 = 1.7%，胆源性败血症 = 1.5%，出血 = 1.3%，穿孔 = 0.4%）。BDS复发率为9.8%，复发的中位时间为7个月（1 - 112个月）。多因素分析显示，男性是结石复发的唯一危险因素（OR：2.242，95%CI：1.304 - 3.853，P = 0.003）。所有ERCP术后出现并发症的患者均入院治疗，中位住院时间为7天（1 - 306天）。90天死亡率为2.1%。
在我们的研究中，初次ERCP在70.9%的病例中实现了结石清除，四分之一的患者需要重复手术。应适当告知患者ERCP的成功率以及替代治疗方案，如对于适合手术的患者，术中成像后进行胆管探查和胆囊切除术。
