Success rate and complications of endoscopic extraction of common bile duct stones over 2 cm in diameter

BackgroundClinically, common bile duct (CBD) stones >2 cm are difficult to remove by endoscopic retrograde cholangio-pancreatography (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.MethodsAll 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.ResultsSeventy-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).ConclusionThe 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.