Lizcano, JGC; Martin, JAG; Sola, AP; Arino, MJM

Hosp Virgen Luz, Digest Serv, Cuenca, Spain

Background and aim: ERCP with biliary sphincterotomy is the usual method to extract common bile duct stones. However, after sphincterotomy and by means of balloons and Dormia baskets not all stones may be extracted during the first endoscopy session. We present our experience regarding success rate after first ERCP. Patients and methods: 100 consecutive patients were included. All were diagnosed with choledocholitiasis by using ERCP. After biliary sphincterotomy, attempts to extract stones by means of balloons and Dormia baskets only were made. Billroth II gastrectomies and bile duct strictures of any origin were excluded. Results: during the first attempt at ERCP, complete stone clearance was achieved in 73 patients. Of the remaining 27 patients: 3 underwent surgery for choledocholithiasis, 20 had a plastic stent inserted, and 4 needed another ERCP for stones having been left in place. Mean extracted stone size was 9.4 mm (+/-3.8), and mean non-extracted stone size was 17 mm (+/-7.3): p<0.001. Male/female ratio was 35/38 in the extracted group and 6/21 in the non-extracted group (p<0.05). There were 11 complications (one patient underwent surgery because of duodenal perforation not related to sphincterotomy). There was no mortality. Conclusions: in our experience, after endoscopic biliary sphincterotomy and by means of balloons and Dormia baskets a complete stone clearance has been achieved in 73% of patients at first encloscopy attempt. Failed extraction seems to be related to stone size and was more frequently found in women.