الفهرس 
? Anatomy of the Biliary SystemOnly 14 pages are availabe for public view
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Abstract
Choledocholithiasis is defined as the occurrence of stones in the bile ducts (David and Nezam, 2010).
Stones in the bile ducts may remain asymptomatic for years but when they do cause symptoms, tend to manifest as life-threatening complications such as cholangitis and acute pancreatitis (David and Nezam, 2010).
ERCP with sphincterotomy (ES) and stone extraction are well-established therapeutic procedures for the treatment of common bile duct (CBD) stones. It is a relatively safe procedure; however, there is potential for severe life-threatening complications (Sugiyama and Atomi, 2000).
This prospective study aimed to identify the epidemiological pattern of calcular obstructive jaundice and to determine the predictors of success and predictors of complications of ERCP management of calcular obstruction of CBD.
It was conducted at the ERCP unit in a private center in Sana`a and in Ain Shams university hospitals during the period from November 2009 to January 2012. One hundred patients presented by calcular obstruction of CBD and managed by ERCP were included in this study “60 patients from Yemen and 40 patients from Egypt “.
In this study we found that the outcome after one session of ERCP management was as follow:
1- Complete success with complete removal of the stones was achieved in 75 patients “75% of all patients” (43 Yemeni patients and 32 Egyptian patients).
2- Failure to remove the stones occurred in 20 patients 20% of all patients” (14 Yemeni patients and 6 Egyptian patients). Stent placement with good CBD drainage was achieved in 16 patients. Cannulation was failed in 4 cases.
3- Five patients presented by calcular obstructive jaundice as diagnosed before ERCP but on doing ERCP the stones passed with stigmata of passed stones “pregnant papilla and open panctum”.
Choledocholithiasis in the present study was observed more in females with main age 52.37. Most of patients were overweight. Clinically; abdominal pain and jaundice were the most common presentation. One case presented by acute pancreatitis. About 41% of patients present with clinical suspension of cholangitis and about half of these associated with leukocytosis. Asymptomatic cases were 4% of patients..
The predictors of success in ERCP procedure to remove the stones completely by univariate analysis were female gender, smaller sized stones, more dilated CBD, lower bilirubin and decrease trials and time for CBD cannulation. Although curved or kinked CBD caused severe difficulty in extracting the stones it had no significant effect on success rate. By multivariate analysis the independent predictors were female gender, decrease time for CBD cannulation, more dilated distal CBD and smaller sized stones.
The predictors of post ERCP pancreatitis by univariate analysis were increased trials and time for CBD cannulation, pancreatic duct cannulation and injection and use of precut needle knife technique. Low inserted cystic duct could be a risk factor for pancreatitis with slight statistical significance. By multivariate analysis the independent predictors were pancreatic duct cannulation and precut needle knife with slight statistical significant.
The predictors of post ERCP bleeding by univariate analysis were endoscopic bleeding, presence of cholangitis before ERCP, coagulopathy, dilated CBD, higher total and direct bilirubin, increased WBCs, presence of pus on ERCP and presence of itching on presentation. By multivariate analysis the independent predictors were the presence of cholangitis before ERCP and bleeding during ERCP.
The predictors of post ERCP cholangitis by univariate analysis were higher bilirubin, increased diameter of the stones. By multivariate analysis the independent predictors were higher level of bilirubin and larger sized stones with slight statistical significance.
The predictors of post ERCP abdominal pain without pancreatitis by univariate analysis were qat chewing, use of tobacco, increased trials and time for CBD cannulation, larger sized stones and increased duration of the procedure. By multivariate analysis the independent predictors for were increased trials of CBD cannulation and increased duration of the procedure.