Single‐centre audit of endoscopic common bile duct stone retrieval

Background: Endoscopic extraction of stones in the bile duct is not without risk, with complications occurring in up to 10 per cent of patients. The aim of this study was to determine the success and complications of stone retrieval by endoscopic retrograde cholangiopancreatography (ERCP) in this institution. Methods: This was a retrospective analysis of a prospective database for all ERCPs (single operator, single institution) between 1990 and 1995. Some 271 consecutive patients with a strong suspicion of bile duct stones, from history or investigations, were studied. All patients underwent ERCP and attempted retrieval of bile duct stones if detected. Treatment success was strictly defined as a stone‐free postprocedure radiograph. All patients were followed to identify complications occurring within 30 days of the procedure. Results: The median age of the 271 patients was 73 (range 17–96) years; 62 per cent were women. Some 139 patients had 162 significant other medical conditions (61 per cent cardiopulmonary) that required specialist treatment. The presenting symptoms included painful jaundice (34 per cent), acute pancreatitis (25 per cent), cholangitis (17 per cent), painless jaundice (14 per cent) and abdominal pain alone (9 per cent). Stones were seen at ERCP in 192 patients (71 per cent); the median number of stones was 1 (range 0–20). Successful endoscopic stone retrieval was achieved in 136 patients (71 per cent) at the first attempt, with an overall success rate of 90 per cent. The median number of ERCPs per patient was 1 (range 1–4). There were five false‐negative ERCPs (2 per cent) and 19 retrieval failures (10 per cent), which included requirement for percutaneous cholangiography or endoscopic stenting for successful treatment. Complications occurred in eight␣patients (3 per cent), and included cholangitis (1␣per cent), pancreatitis (less than 1 per cent) and haemorrhage (less than 1 per cent). There were two procedure‐related deaths (1 per cent), from myocardial infarction and cholangitis. Conclusion: Endoscopic stone retrieval can be achieved successfully with low morbidity and mortality rates, even in patients with significant co‐morbidity. These data provide further support for dedicated units offering a regional ERCP service. © 1999 British Journal of Surgery Society Ltd