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Factors influencing endoscopic clearance of bile duct stones

December's issue of Gastrointestinal Endoscopy identifies factors influencing the technical difficulty of endoscopic clearance of bile duct stones.

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There has been no report concerning the factors that contribute to the technical difficulty of endoscopic clearance of common bile duct stones.

Dr Hong Joo Kim and colleagues from Korea determined the factors that contribute to the technical difficulty of endoscopic clearance of common bile duct stones at a tertiary referral endoscopy center.

Technical difficulties occurred with more acute distal common bile duct angulation
Gastrointestinal Endoscopy

The team identified a total of 102 patients who underwent ERCP, endoscopic biliary sphincterotomy, and common bile duct stone extraction between 2004 and 2006.

The team graded the technical difficulty of stone clearance from easy, moderately difficult, very difficult, to failed.

Distal common bile duct angulation seen on cholangiogram was defined as the first angulation from the ampullary orifice with the patients in the prone position.

The distal arm of common bile duct angulation was defined as the length in millimeters between angular point and ampullary orifice.

The researchers found that age over 65 years, previous gastrojejunostomy, and larger common bile duct stone contributed to technical difficulties of bile duct stone clearance.

Impacted common bile duct stone, use of mechanical lithotripsy, and shorter length of the distal common bile duct arm were also contributing factors.

The team noted that more acute distal common bile duct angulation of 135 degrees was a contributing factor to the technical difficulty of common bile duct stone clearance.

In the definitive multivariate analysis, more acute distal common bile duct angulation was a significant, independent contributor to technical difficulty.

In addition, the researchers found that a shorter length of the distal common bile duct arm was a significant, independent contributor to technical difficulty.

Dr Kim's team concluded, "Complete clearance of common bile duct stones was technically more difficult for the patients with more acute distal common bile duct angulation, and a shorter length of the distal common bile duct arm."

Gastrointest Endoscopy 2007: 66(6): 1154-60
11 December 2007

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