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jsmc-10099


USES OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN THE MANAGEMENT OF BILE DUCT STONES IN KURDISTAN CENTER FOR GASTROENTEROLOGY AND HEPATOLOGY


Ali Fadhil Al-Najjar * and Taha Karboly **


*  Department of Anatomy, College of Medicine, University of Sulaimani.
** Department of Medicine, College of Medicine, University of Sulaimani.


Submitted: 5/8/2015; Accepted: 1/8/2016Published: 1/12/2016


ABSTRACT


Objectives

The purpose of this study is to document the extent of pre and post-cholecystectomy retained bile duct stones in our region with evaluation of the endoscopic retrograde cholangio pancreatography role in their management.

Design

Retrospective study.

Patients and Methods

This retrospective case series was carried out in Kurdistan center for gastroenterology and Hepatology in Sulaimani city–Iraq from January 2014 to January 2015. The records of 486 patients were retrospectively evaluated to collect demographic, clinical and procedure related data.

Results

The mean age was 51 years (range14-88 years).The female : male ratio was 2.01:1 with females constituted 325 (66.87%) while males constituted 161 (33.12%).Less than quarter of the patients were referrals from Iraqi governorates other than Sulaimani governorate. The mean duration of the ERCP procedure was 27.5 min. Deep cannulation was successful in 452 (93.o1%) patients. There was 34 (6.99%) failure of cannulation. In cases that had successful cannulation a cholangiogram was obtained which showed bile duct dilatation. Endoscopic sphincterotomy is almost done in all cases before stone extraction, and it is an adjunct for stone removal which is done by basket or balloon. It was performed in 285 (84.2%) patients, followed by stone extraction in 341 (96.05%) patients, stenting in 208 (45.51%). The most common complications reported in this study were pancreatitis, bleeding and cholangitis. Elevated liver function tests and dilated CBD by ultrasound are the most accurate predictors of stones.

Conclusion

Despite its associated morbidity and risk of mortality, ERCP (Endoscopic Retrograde Cholangio Pancreatography) is an important method in managing pre and post cholecystectomy choledocholithiasis. Our indications, interventions and complications rates are comparable to those reported in other countries.

KEYWORDS

ERCP, KCGH, Sulaimani, endoscopic sphincterotomy, choledocholithiasis.

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