title: Success rate and complications of endoscopic extraction of common bile duct stones over 2 cm in diameter.
abstract: BACKGROUND
  Clinically, common bile duct (CBD) stones >2 cm are difficult to remove by endoscopic retrograde cholangiopancreatography (ERCP). To evaluate this observation, the rates of successful clearance of CBD stones and complications were compared between ERCP extraction of CBD stones of >2 cm and <2 cm in diameter.
  
  
  METHODS
  All patients who had undergone endoscopic extraction of CBD stones at the Endoscopy Center of Shanghai First People's Hospital from May 2004 to May 2008 were reviewed. Patients with CBD stones of >2 cm in diameter were enrolled in the >2 cm group. Two matched controls with CBD stones of <2 cm in diameter were selected for each enrolled patient (<2 cm group). Patient characteristics, success rates, and complications during and after ERCP were compared.
  
  
  RESULTS
  Seventy-two patients constituted the >2 cm group and 144 patients were in the <2 cm group. No significant differences were found in the patient characteristics, except for stone size and CBD diameter. Both the overall success rate and the success rate in the first ERCP session were lower in the >2 cm group (77.8% and 58.3%, respectively) than in the <2 cm group (91.7% and 83.3%, P<0.01). During ERCP, the incidence of hypoxemia (30.6%) and hemorrhaging papillae (18.1%) in the >2 cm group was higher than in the <2 cm group (13.2% and 6.3%, P<0.05). After ERCP, the rates of delayed papillae hemorrhage (13.9%), hyperamylasemia (23.6%), acute pancreatitis (8.3%) and biliary infection (18.1%) were higher in the >2 cm group than in the <2 cm group (3.5%, 11.1%, 2.1%, and 2.8%, respectively, P<0.05).
  
  
  CONCLUSIONS
  The success rate of endoscopic extraction of CBD stones of >2 cm in diameter was lower but the complication rate was higher than that of stones of <2 cm in diameter.
authors.affiliation: Department of Gastroenterology, Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai, China. wanxj99@ 163.com
authors.forename: Xin-Jian
authors.initials: XJ
authors.lastname: Wan
authors.forename: Zheng-Jie
authors.initials: ZJ
authors.lastname: Xu
authors.forename: Feng
authors.initials: F
authors.lastname: Zhu
authors.forename: Lei
authors.initials: L
authors.lastname: Li
mesh_terms: D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002681:China; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome