Introduction:

Choledocholithiasis is defined as the presence of stones in the common bile duct. The majority of the stones in the common bile duct originate in the gallbladder. Different studies have reported that choledocholithiasis occurs in 16% of patients operated on for gallbladder lithiasis. Most of the bile duct stones can be extracted with conventional measures (Instrumentation with basket or balloon) in 80-91%.

Objective:

The main objective of this study is to describe the endoscopic management of choledocholithiasis in patients who underwent endoscopic retrograde cholangiography (ERCP) at Juarez Centro Medical-Surgical Unit.

Material and methods:

We present a retrospective, cross-sectional, observational, descriptive, and comparative study that was conducted in the Gastrointestinal Endoscopy Service of the Juárez Centro Surgical Medical Unit in Mexico City, during the period of the 1st October 2018 to March 31, 2019.

Results:

A total of 122 studies of ERCP were performed in the Gastrointestinal Endoscopy Service of the Juárez Centro Medical-Surgical Unit, of which 53 were diagnosed with choledocholithiasis, of which 7 (13.2%) were male patients. 46 (86.8%), average age was 42.53 years. The presentation of the lithium the average size of the stone was 10.25mm with a fashion of 5mm, a minimum size of 5mm and a maximum size of 30mm, being only 17% (9) greater than 15mm, having a frequency of 64.2% (34) presentation of single stone and 35.8% (19) with multiple choledocholithiasis, the oviode shape had a higher frequency of presentation in 58.5% (31) and facetato (several sides, triangular or hexagonal) in one 41.5% (22). With regard to localization, 98.1% (52) was in the extrahepatic bile duct and 1.9% (1) with intrahepatic presentation. The anatomy of the bile duct was presented in 88.8% (47) without alterations and in 11.3% (6) with agulations greater than 130º. For the treatment of choledocholithiasis, sphincterotomy was performed in 98.1% of the ERCPs and in only 1.9% (1) no sphincterotomy was performed, a balloon cannula was performed in 100% of the cases. Sphincteroplasty was performed in 47.2% (25) and mechanical lithotripsy in 7.5% (4). Achieving a clearing of the bile duct in 75.5% (40) of cases and the need to place a plastic prosthesis for tempororal drainage of the bile duct in 24.5% (13). Complications during the procedure were 3.8% (2) included in one case of sphincterotomy bleeding (1.9%) and one case of rupture of the basket (1.9%). Binary logistic regression was performed for lithium size greater than 15mm, finding coefficient B of 3.099 and standard error of the model of 0.914 with an OR of 22.167 (95% CI 3.694-133.06) with a P = 0.001. For sphincteroplasty coefficient B of 2.324 with a standard error of the model of 0.837, an OR of 10.214 (95% CI 1.980-52.696) with a P = 0.006.

Conclusions:

ERCP in our experience has been shown as a safe, useful and effective procedure for the diagnosis and treatment of choledocholithiasis of patients who come referred to our service.

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