Factors Significantly Contributing to a Failed Conventional Endoscopic Stone Clearance in Patients with “Difficult” Choledecholithiasis: A Single-Center Experience
Selected criteria potentially contributing to the difficulty of endoscopic SE.
15 mm in diameter
Acute distal CBD angulationb
Age 85 years
Postgastrectomy Billroth type II or Roux-en-Y reconstruction
4 in number (multiple stones)
Presence of T-tube in situ + proximal lithiasis
Iatrogenic injury to the extrahepatic biliary tree + lithiasis
Intrahepatic or cystic duct stones
Defined endoscopically as a depressed lesion of 5 mm or more with intact mucosa and with the major papilla either within it or close by .
bDefined as the sharpest angle along the CBD from 1 cm below the bifurcation to 1 cm above the papilla .