title: Factors significantly contributing to a failed conventional endoscopic stone clearance in patients with "difficult" choledecholithiasis: a single-center experience.
abstract: The objective of this study is to retrospectively evaluate factors significantly contributing to a failed stone extraction (SE) in patients with difficult to extract bile duct stones (BDS). Patients and Methods. During a 10-year period 1390 patients with BDS underwent successfully endoscopic sphincterotomy. Endoscopic SE was graded as easy; relatively easy; difficult; and failed. Difficult SE was encountered in 221 patients while failed SE was encountered in 205. A retrospective analysis of the criteria governing the difficulty of endoscopic SE following the index endoscopic intervention was performed to evaluate their significance in determining failure of complete SE among patients with difficult to extract bile duct stones. Results. Age ≥ 85 years, periampullary diverticula, multiple CBD stones (>4), and diameter of CBD stones (≥15 mm) were all significant contributing factors to a failed SE in univariate statistical tests. In the definitive multivariate analysis age, multiple stones and diameter of stones were found to be the significant, independent contributors. Conclusion. Failed conventional endoscopic stone clearance in patients with difficult to extract BDS is more likely to occur in overage patients, in patients with multiple CBD stones >4, and in patients with CBD stone(s) diameter ≥15 mm.
authors.affiliation: Fourth Surgical Department, Endoscopic Unit, "George Papanikolaou" Hospital, Aristotle University, Exohi, 57010 Thessaloniki, Greece.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Christoforidis
authors.affiliation: First Department of General Surgery, Section of Hepatopancreatobiliary Surgery, "Papageorgiou" Hospital, Nea Efkarpia, 56 403 Thessaloniki, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Vasiliadis
authors.affiliation: Fourth Surgical Department, Endoscopic Unit, "George Papanikolaou" Hospital, Aristotle University, Exohi, 57010 Thessaloniki, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tsalis
authors.affiliation: Fourth Surgical Department, Endoscopic Unit, "George Papanikolaou" Hospital, Aristotle University, Exohi, 57010 Thessaloniki, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Patridas
authors.affiliation: Department of General Surgery, General Hospital of Drama, End of Hippokratous Street, 66100 Drama, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Blouhos
authors.affiliation: Fourth Surgical Department, Endoscopic Unit, "George Papanikolaou" Hospital, Aristotle University, Exohi, 57010 Thessaloniki, Greece.
authors.forename: Manousos-Georgios
authors.initials: MG
authors.lastname: Pramateftakis
authors.affiliation: Fourth Surgical Department, Endoscopic Unit, "George Papanikolaou" Hospital, Aristotle University, Exohi, 57010 Thessaloniki, Greece.
authors.forename: Moysis
authors.initials: M
authors.lastname: Moysidis
authors.affiliation: Fourth Surgical Department, Endoscopic Unit, "George Papanikolaou" Hospital, Aristotle University, Exohi, 57010 Thessaloniki, Greece.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Lazaridis