Aims
To identify the predictors of failed CBD stone clearance without cholangitis during ERCP
Methods
retrospective analysis of patients who underwent ERCP for CBD stone clearance at a tertiary care centre in New Delhi between January 2023 and July 2023. Univariate and multivariate analyses were performed to identify predictors of CBD stone clearance
Results
A total of 245 patients were included in the analysis. Successful clearance was achieved in 73.06% of the cases. Univariate analysis revealed that abdominal pain, CBD diameter, stone size >12 mm, and stone size/CBD diameter >1 on magnetic resonance cholangiopancreatography (MRCP) were significantly associated with failed clearance. Endoscopic and cholangiographic parameters, such as bulky papilla, difficult cannulation, CBD diameter, stone size >12 mm, middle location of the stone, stone size/CBD diameter >1, impacted stone, and CBD stricture, were also significantly associated with failed clearance. On multivariate analysis, middle stone location (odds ratio [OR] 4.44; 95% CI, 1.67-11.75), stone size/CBD diameter >1 (OR 5.22; 95% CI, 1.14-23.78), CBD stricture (OR 5.06; 95% CI, 1.006-25.52), and impacted stone (OR 9.33; 95% CI, 2.17-39.99) were identified as independent predictors of failed CBD clearance.
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(A) Baseline Lab parameters |
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|
S. No |
Parameters |
Not cleared (66) |
Cleared (179) |
P value |
|
1 |
Hb (g/dL) |
11.9 (10.5-12.97) |
11.9 (10.9-12.7) |
0.83 |
|
3 |
Platelets (cells ×10⁵/mm³) |
2.3 (1.63-2.87) |
2.3 (1.7-3.0) |
0.59 |
|
4 |
Total Bilirubin (mg/dl) |
0.9 (0.5-2.05) |
0.7 (0.5-1.3) |
0.076 |
|
5 |
ALT (IU/L) |
34 (20-94) |
42 (23-83) |
0.28 |
|
6 |
AST (IU/L) |
38.5 (27-75.5) |
41 (26-78) |
0.97 |
|
7 |
ALP (IU/L) |
188 (129-346) |
180 (127-312) |
0.86 |
|
8 |
CBD Diameter >15mm |
13(19.7%) |
19 (10.6%) |
0.06 |
|
9 |
CBD Diameter in mm |
11.93 ±4.57 |
10.68 ±3.41 |
0.02 |
|
10 |
Stone No (>3) |
3 (4.5%) |
12(6.7%) |
0.52 |
|
11 |
Stone Size >12 mm
|
16 (24.2%) |
16 (8.9%) |
0.001 |
|
12 |
Stone Size in mm |
9.97 ±4.90 |
7.73 ±3.36 |
0.0001 |
|
13 |
Location of stone (proximal) |
12 (18.2%) |
18 (10.1%)
|
0.57 |
|
14 |
PAD |
6 (9.1%) |
17 (9.5%) |
0.94 |
|
15 |
Bulky Papilla |
6 (9.1%) |
5 (2.8%) |
0.03 |
|
16 |
Difficult cannulation |
16 (24.2%) |
14 (7.8%) |
0.001 |
|
17 |
CBD Diameter >15mm |
9 (13.6%) |
20 (11.2%) |
0.10 |
|
18 |
CBD Diameter in mm |
13.11 ±5.10 |
11.72 ±3.34 |
0.02 |
|
19 |
Stone No (>3) |
3 (4.5%) |
19 (10.6%) |
0.51 |
|
20 |
Stone Size in mm |
13.77 ±6.03 |
8.93 ±3.89 |
0.0001 |
|
21 |
Location of stone (proximal) |
8 (12.1%) |
18 (10.05%) |
0.02 |
|
22 |
CBD stricture |
4 (6.1%) |
3 (1.6%) |
0.06 |
|
23 |
Hepatolithiasis |
8 (12.1%) |
10 (5.6%) |
0.08 |
|
24 |
Impacted stone |
16 (24.2%) |
5 (2.8%) |
0.0001 |
|
25 |
Use of a Basket for Extraction |
1 (1.5%) |
3 (1.7%) |
0.94
|
Conclusions
dentifying these predictive factors may help stratify patients for appropriate advanced management strategies, such as cholangioscopy-assisted extraction, electrohydraulic lithotripsy, or surgical management.