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2020, Number 1

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Rev Mex Cir Endoscop 2020; 21 (1)

5-year experience in the management of patients with high risk of choledocholithiasis

Marín-López JJ, Flores-Álvarez E, Gómez-Arámbulo R, De TGJC, Chávez FD, Rodríguez OJA, Olivares MJI

Language: Spanish
References: 34
Page: 26-31
PDF size: 203.43 Kb.


ABSTRACT

Introduction: Choledocholithiasis develops in 8 to 18% of patients with lithiasic cholecystitis. The diagnosis is established based on the criteria of the American Society for Gastrointestinal Endoscopy (ASGE). In high-risk patients, the suggested treatment is endoscopic retrograde cholangiopancreatography (ERCP), although the common bile duct exploration (BDE) has shown similar results in terms of effectiveness and complications. There is still controversy regarding the best treatment option. Objective: Analysis and description of our experience in the management of patients with high risk of choledocholithiasis in the Centenario Hospital Miguel Hidalgo in a period of five years. Material and methods: Retrospective, descriptive, analytical and comparative case series study of patients with high risk of choledocholithiasis, generating two groups based on treatment: endoscopic retrograde cholangiopancreatography (ERCP) or bile duct exploration (BDE). Description of qualitative and quantitative variables with percentages and measures of central tendency, χ2 for categorical variables, Student t or U Mann-Whitney according to data normality. Results: Sample of 76 patients with high risk of choledocholithiasis, 55 (72.37%) female and 21 (27.63%) male. Mean age 43 years (SD ± 19.07). ERCP was therapeutic in 41 cases (56.94%), non-therapeutic in 31 (no bile duct clearance, n = 20; stone absence, n = 11) and ERCP was not performed in four cases. 24 patients were treated with BDE, resolving 95%. No association found between type of approach and complications (p = 0.823). Pos-ERCP pancreatitis occurs in 18.42%. Hospital stay with ERCP was 9 days (± 12, 2-87) and with EVB 8 days (± 5, 2-21). Conclusion: In our sample the BDE is the procedure with most cases resolved. Deciding the treatment strategy will depend of the experience and resource in each institution.


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