ERCP on a cohort of 2,986 patients with cholelitiasis: a 10-year experience of a single center.

Background & Aims: Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is the standard method of treatment for choledocholithiasis. We evaluated the diagnostic success rate and the outcomes of therapeutic ERCP for bile duct stones, in relation to the anatomical variants.

Method: A total of 3,097 consecutive ERCPs were performed in 2,986 patients during a 10-year period (2002-2011) in our endoscopy department. The analysis of the results of therapy was performed in relation to the anatomical variants, patients' age, opacification of the Wirsung duct and recurrent lithiasis.

Results: The rate of successful cannulation was 98%. The patient's age and the diameter of the common bile duct were the factors influencing the probability of finding a gallstone: age over 74 years, AUC=0.547 (p<0.001) and a CBD diameter larger than 12 mm (AUC=0.735, p<0.001). The number of cases with opacification of the Wirsung duct, the use of precut papillotomy and the inability of finding a stone significantly decreased with the increasing experience of the operator (p<0.001). The stone removal was unsuccessful in 2.3%. Factors associated independently with unsuccessful extraction were previous surgical sphincteroplasty, stone size and Billroth I anastomosis. Ninety two patients (4.3%) were diagnosed with recurrent lithiasis. Factors associated independently with recurrence were stone size (p=0.002, OR=0.35), dilation of infundibulum (p=0.04, OR=0.13) and the presence of periampullary diverticula (p=0.004, OR=0.28).

Conclusions: The endoscopic treatment of choledocholithiasis is highly effective. It is influenced partly by the experience of the operator. In experienced hands, the success rate is high even in cases of anatomical variants and difficult calculi.