A Study on Clinical features, success rate and complications of endotherapy in choledocholithiasis

Manimaran, M (2010) A Study on Clinical features, success rate and complications of endotherapy in choledocholithiasis. Masters thesis, Kilpauk Medical College, Chennai.

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Abstract

INTRODUCTION: Choledocholithiasis is defined as the occurrence of stones in the bile ducts. It is a common clinical problem worldwide. It has been estimated that 10–15% of patients undergoing cholecystectomy for symptomatic gallstones harbor concomitant stones in their CBD. Primary ductal stones formed de novo also add a further small percentage to the overall prevalence. OBJECTIVES: 1. To study the various clinical presentations of choledocholithiasis. 2. To study the success rate of endotherapy in choledocholithiasis. 3. To study the complications of endotherapy in choledocholithiasis. 4. To study the epidemiology of choledocholithiasis. 5. To study the associated conditions with choledocholithiasis. MATERIALS AND METHODS: This is a prospective study conducted in DDHD, Government peripheral Hospital, Anna Nagar, Chennai – 102 from April 2008 to December 2009. INCLUSION & EXCLUSION CRITERIA: 1. All patients with CBD stones who underwent ERCP were included in this study. 2. Patients with CBD stones not willing for ERCP were excluded from this study. 3. Patients with CBD stones who were all not fit for ERCP excluded. 4. Patients with obstructive jaundice other than CBD stones were excluded. All patients were explained about the procedure and its complications. We got informed consent from all the patients. ERCP was performed by the Professor and the Associate Professor of our department. All patients received premedications Inj. pentazocine 30mg (1cc), Inj.promethazine 50mg (2cc), Inj. hyoscine butylbromide 20mg (1cc), and Inj.midazolam 2mg I.V. RESULTS: In this study, the patients were divided into three groups; Group 1- Patients with CBD stones with GB stones, Group 2- Patients with CBD stones with no stones in GB, Group 3- Patients with CBD stones in postcholecystectomy state. Total number of patients underwent ERCP in our study were 115. Out of which 51 were males and 64 were females. Overall success rate was 91.3%. Failure rate was 8.69%. The procedure was successful in 95 patients in first attempt, 12 patients in second attempt, and 8 patients in third attempt. Abdominal pain was the presenting symptom in 70 [60.86%] patients, Jaundice in 44 [38.26%], Fever in 42 [36.52%], Charcots triad in 38 [33.04%], Biliary pancreatitis in 6 [5.21%], Asymptomatic in 4 [3.47%] patients. 38 patients developed post procedural abdominal discomfort, 13 patients developed pancreatitis [Mild-9, Moderate -4, and Severe - 0], and 2 patients had retroduodenal perforation. No post sphincterotomy bleeding noted. No procedure related mortality was noted in this study. CONCLUSION 1. Most common presentation of CBD stones in this study was abdominal pain 60.86%, followed by jaundice 38.26%, and fever 36.52%.Charcots triad was seen in 33.04%. 2. In the study, overall success rate was 91.3% and failure rate was 8.69%. 3. Overall complication rate was 13.04%. No post sphincterotomy bleeding was noted. No procedure related mortality was noted. Hence endotherapy are very effective with fewer complications in the treatment of choledocholithiasis. 4. CBD Stones were more common in females (F- 64 pts, M- 51 pts). Mean age of presentation was 49.91 years (range 9 – 76 yrs). 5. Biliary ascariasis was seen in one patient, choledochal cyst type 1 was seen in 2 patients, periampullary diverticulum was seen in 15 patients, distal CBD stricture was seen in 19 patients and intra hepatic stones were seen in 3 patients. 6. There was no statistically significant difference in clinical presentations, associated features, success rate and complications of endotherapy in all the three groups of choledocholithiasis.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Clinical features, success rate, complications, endotherapy, choledocholithiasis.
Subjects: MEDICAL > Gastroenterology
Depositing User: Subramani R
Date Deposited: 07 Mar 2020 04:19
Last Modified: 07 Mar 2020 05:26
URI: http://repository-tnmgrmu.ac.in/id/eprint/12159

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