Outcome of Management of Large Common Bile Duct Stones | ||
| Zagazig University Medical Journal | ||
| Articles in Press, Accepted Manuscript, Available Online from 06 October 2025 | ||
| Document Type: Original Article | ||
| DOI: 10.21608/zumj.2025.418313.4137 | ||
| Authors | ||
| Mohamed Suliman Ibrahim Alayeb* 1; mohammad Farouk mogahed2; Wael Salah Eldin Mansy3; Mohamed Adel Ahmed Saleh1 | ||
| 1General Surgery department, Faculty of Medicine, Zagazig University, Zagazig, Egypt. | ||
| 2general surgery faculty of medicine zagazig university | ||
| 3General surgery department zagazig university | ||
| Abstract | ||
| Background: Large CBD stones (≥15 mm) are difficult to remove and need fragmentation if larger than 20 mm. ERCP, laparoscopic, percutaneous, or open surgery are available depending on experience. Large or impacted stones require open surgery, but ERCP with sphincterotomy, balloon dilatation, lithotripsy, or SpyGlass is less invasive. This research compared endoscopic and surgical treatment of large CBD stones. Methods: Our prospective cohort of 30 patients (>1.5 cm CBD stones, mean age 56.4 ± 10.1 years, 56.7% females) was studied between January 2024 and June 2025. ERCP was performed in 18 cases (60%), SpyGlass in 6 (20%), and surgery in 6 (20%; 13.3% open, 6.7% laparoscopic). Stone size was 15.7 ± 2.95 mm (ERCP), 14 ± 1.09 mm (SpyGlass), and 17.3 ± 3.62 mm (surgery). All patients underwent clinical, laboratory, and imaging assessment, with exclusion of malignancy or major contraindications. Results: Stone size and CBD diameter changed considerably (p<0.001), with the biggest difference during operation. Surgery and SpyGlass had greater total and direct bilirubin than ERCP (p=0.02 and 0.03). Surgical time was longest, SpyGlass middle, and ERCP shortest (p<0.001). SpyGlass inserted numerous stents more often (p=0.0001). Surgery hospital stay was longest, ERCP/SpyGlass shortest (p=0.002). In surgery, pain and intraoperative blood loss were much greater (p<0.001). No death occurred. Conclusion: ERCP proved effective and minimally invasive with shorter operative time and hospitalization. SpyGlass was a safe alternative of moderate duration, whereas surgery, reserved for larger stones, involved longer operations, higher complications, and prolonged stay. | ||
| Keywords | ||
| Common bile duct stones; ERCP; SpyGlass cholangioscopy; Surgical exploration; Stone clearance outcomes | ||
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