Is ERCP really necessary in case of suspected spontaneous passage of bile duct stones?

Sakai, Yuji; Tsuyuguchi, Toshio; Ishihara, Takeshi; Yukisawa, Seigo; Ohara, Tadashi; Tsuboi, Masaru; Ooka, Yoshihiko; Kato, Kazúo; Katsuura, Kiyotake; Kimura, Michio; Takahashi, Makoto; Nemoto, Kazuhisa; Miyazaki, Masaru; Yokosuka, Osamu

doi:10.3748/wjg.15.3283

Cited by 15 publications

(18 citation statements)

References 26 publications

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“…Some studies suggested that performing MRCP first in patients have improved clinical and hematological parameters. If the stone has spontaneously passed, it would reduce the exposure of ERCP and complication due to ERCP [ 10 , 20 ]. Our study found that post-ERCP pancreatitis was 21.1% in spontaneous CBD stone passage.…”

Section: Discussionmentioning

confidence: 99%

The influence of stone size on spontaneous passage of common bile duct stones in patients with acute cholangitis: A retrospective cohort study

Sanguanlosit

Viriyaroj

Yodying

et al. 2020

Annals of Medicine and Surgery

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Background The common bile duct (CBD) stones passage in patients with cholangitis was unclear. This study aimed to evaluate the effect on CBD stone sizes and predicting factors on spontaneous passage in patients with cholangitis. Method The medical records of cholangitis at Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University from January 2014 to December 2019 were retrospectively reviewed. Patients with acute cholangitis from CBD stones underwent ERCP in the same admission were enrolled. Result Of the 96 patients, The rate of spontaneous passage of CBD stones was 19.8%. By univariate analysis, factors significantly associated with a predictor of spontaneous CBD stone passage in patient with cholangitis were single CBD stone (p = 0.001), CBD stone diameter < 5 mm (p < 0.001), and clinical symptom improved before ERCP procedure (p = 0.004). Multivariate logistic regression analyses also revealed that these three factors were significantly associated with spontaneous passage. From ROC curve analysis, stone size of less than 4.85 mm was more likely to pass spontaneously with acceptable sensitivity (81.8%) and specificity (78.9%). Conclusions CBD stone diameter < 5 mm, single CBD stone and improved clinical symptom before ERCP procedure are key predictors of spontaneous CBD stone passage in cholangitis.

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Section: Discussionmentioning

confidence: 99%

The influence of stone size on spontaneous passage of common bile duct stones in patients with acute cholangitis: A retrospective cohort study

Sanguanlosit

Viriyaroj

Yodying

et al. 2020

Annals of Medicine and Surgery

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“…Post-ERCP pancreatitis (PEP) is one of the most serious complications of ERCP. In recent years, computed tomography and/or magnetic resonance cholangiopancreatography (MRCP) have become more highly applicable diagnostic approaches for pancreatic and biliary system diseases than ERCP [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Post-Endoscopic Retrograde Pancreatography Pancreatitis: A Retrospective Chart Review in a Regional Hospital in Japan

et al. 2019

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Background: Endoscopic retrograde pancreatography (ERCP) is sometimes complicated by post-ERCP pancreatitis (PEP), which is a severe adverse effect. Objective: The present study was performed to (i) evaluate the risk factors for PEP and (ii) compare the risk of PEP after ERCP performed in the off hours versus regular hours. Methods: This retrospective study included 374 patients who underwent ERCP from January 2013 to December 2017. Among these patients, 38 (10.2%) developed PEP. The potential risk factors for PEP were evaluated by multivariate regression analysis, and the risk of PEP was compared between ERCP performed during regular hours and off hours. Results: The independent risk factors for PEP were a relatively younger age (< 75 years; p = 0.024), female sex (p = 0.002), a history of pancreatitis (p = 0.044), and performance of pancreatography (p = 0.010). Use of a diclofenac suppository and performance of pancreatic stenting were not preventive for PEP after ERCP. The complication rate of PEP did not differ between ERCP performed during the off hours versus regular hours. Conclusions: A relatively younger age (< 75 years), female sex, a history of pancreatitis, and performance of pancreatography were potential risk factors for PEP, whereas the risk of PEP was not different between ERCP performed during the off hours versus regular hours.

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“…Considering that stones were spontaneously eliminated in 2 patients among the patients with bile duct stone in the present study, moreover, since attainment to the papilla and subsequent treatment are more difficult in the patients with Billroth II-reconstructed stomach than usual patients, it may be better to perform MRCP at first and then to follow-up the patients without conducting the ERCP, as much as possible, if no stone is identified[28-30]. The treatment with endoscope on biliopancreatic disease in the patients with Billroth II-reconstructed stomach is less invasive, which is considered the treatment to be tried at first.…”

Section: Discussionmentioning

confidence: 99%

Utility of endoscopic retrograde cholangiopancreatography on biliopancreatic diseases in patients with Billroth II-reconstructed stomach

Sakai¹,

Tsuyuguchi²,

Mikata³

et al. 2017

WJGE

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AIMTo examine the utility of endoscopic retrograde cholangiopancreatography (ERCP) on biliopancreatic diseases in the patients with Billroth II-reconstructed stomach.METHODSFor 26 cases of biliopancreatic diseases in patients with Billroth II-reconstructed stomach, ERCP was conducted using a straight-view scope or a retrograde oblique-viewing endoscope. All the cases were patients aiming at selective insertion into the bile duct. One patient aimed at diagnosis, and 25 patients aimed at treatment. The cases in which the endoscope reached the duodenal papilla and anastomosis, and insertion into the bile duct became possible, were considered successful.RESULTSThe rate of reaching the duodenal papilla and anastomosis was 84.7% (22/26 patients). Among the cases without reaching the duodenal papilla and anastomosis, there were 2 in which the endoscope did not pass due to tumor-induced duodenal infiltration. In 1 case, the fiber did not reach the duodenal papilla due to long afferent loop. The success rate of insertion into the bile duct in patients in which the endoscope reached the duodenal papilla and anastomosis was 90.9% (20/22 patients), and the success rate of procedures including treatment was 86.3% (19/22 patients). After treatment, mild cholangitis was observed in 1 patient (4.5%, 1/22 patients) but relieved conservatively. No other accidental symptom was observed.CONCLUSIONIt was considered that the ERCP for biliopancreatic diseases in patients with Billroth II-reconstructed stomach will become a less invasive, safe and useful examination and treatment approach.

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Is ERCP really necessary in case of suspected spontaneous passage of bile duct stones?

Cited by 15 publications

References 26 publications

The influence of stone size on spontaneous passage of common bile duct stones in patients with acute cholangitis: A retrospective cohort study

The influence of stone size on spontaneous passage of common bile duct stones in patients with acute cholangitis: A retrospective cohort study

Risk Factors for Post-Endoscopic Retrograde Pancreatography Pancreatitis: A Retrospective Chart Review in a Regional Hospital in Japan

Utility of endoscopic retrograde cholangiopancreatography on biliopancreatic diseases in patients with Billroth II-reconstructed stomach

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