Factors influencing the technical difficulty of endoscopic clearance of bile duct stones.
BACKGROUND
There has been no report concerning the factors that contribute to the technical difficulty of endoscopic clearance of common bile duct (CBD) stones.


OBJECTIVE
Our purpose was to determine the factors that contribute to the technical difficulty of endoscopic clearance of CBD stones.


METHODS
Prospective study.


METHODS
A tertiary referral endoscopy center.


METHODS
A total of 102 patients who underwent ERCP, endoscopic biliary sphincterotomy, and CBD stone extraction at our institution from August 2004 to September 2006.


METHODS
The technical difficulty of CBD stone clearance was graded as follows: easy, moderately difficult, very difficult, and failed. Distal CBD angulation seen on cholangiogram was defined as the first angulation from the ampullary orifice with the patients in the prone position and the distal arm of CBD angulation as the length (in millimeters) between angular point and ampullary orifice.


RESULTS
Older age (>65 years), previous gastrojejunostomy, larger CBD stone (>/=15 mm), impacted CBD stone, use of mechanical lithotripsy, shorter length of the distal CBD arm (</=36 mm), and more acute distal CBD angulation (</=135 degrees) were all significant contributing factors to the technical difficulty of CBD stone clearance in exploratory univariate statistical tests. In the definitive multivariate analysis, more acute distal CBD angulation and a shorter length of the distal CBD arm were found to be significant, independent contributors to technical difficulty.


CONCLUSIONS
Complete clearance of CBD stones was technically more difficult for the patients with more acute distal CBD angulation and a shorter length of the distal CBD arm.
Kim
Hong Joo
HJ
Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Choi
Hyo Sun
HS
Park
Jung Ho
JH
Park
Dong Il
DI
Cho
Yong Kyun
YK
Sohn
Chong Il
CI
Jeon
Woo Kyu
WK
Kim
Byung Ik
BI
Choi
Seon Hyeong
SH
D000368:Aged; D002769:Cholelithiasis / Q000150:complications* / Q000473:pathology / Q000628:therapy*; D003135:Common Bile Duct / Q000473:pathology; D004108:Dilatation, Pathologic; D005260:Female; D042882:Gallstones / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016717:Sphincterotomy, Endoscopic / Q000379:methods