National Survey Regarding the Management of Difficult Bile Duct Stones in South Korea

• Published in: Gut and liver Vol. 17; no. 3; pp. 475 - 481
• Main Authors: Lee, Yoon Suk, Jeon, Tae Joo, Paik, Woo Hyun, Ahn, Dong-Won, Chung, Kwang Hyun, Son, Byoung Kwan, Song, Tae Jun, Moon, Sung-Hoon, Lee, Eaum Seok, Lee, Jae Min, Yoon, Seung Bae, Paik, Chang Nyol, Lee, Yun Nah, Park, Jin-Seok, Lee, Dong Wook, Park, Sang Wook, Chon, Hyung Ku, Cho, Kwang Bum, Park, Chang Hwan
• Format: Journal Article
• Language: English
• Published: Korea (South) Editorial Office of Gut and Liver 01.05.2023; Gastroenterology Council for Gut and Liver; 거트앤리버 소화기연관학회협의회
• Subjects: bile ducts; cholangiopancreatography endoscopic retrograde; Cholangiopancreatography, Endoscopic Retrograde - methods; endoscopy; gallstones; Gallstones - surgery; Humans; Original; Republic of Korea; Sphincterotomy, Endoscopic - methods; surveys and questionnaires; Treatment Outcome; 내과학; Republic of Korea; Gallstones; Cholangiopancreatography endoscopic retrograde; Surveys and questionnaires; Endoscopy; Bile ducts
• ISSN: 1976-2283; 2005-1212
• DOI: 10.5009/gnl220117

This study aimed to investigate the patterns of preferred endoscopic procedure types and techniques for managing difficult common bile duct (CBD) stones in South Korea. The Committee of Policy and Quality Management of Korean Pancreatobiliary Association (KPBA) conducted a survey containing 19 questions. Both paper and online surveys were carried out; with the paper survey being conducted during the 2019 Annual Congress of KPBA and the online survey being conducted through Google Forms from April 2020 to February 2021. The response rate was approximately 41.3% (86/208). Sixty-two (73.0%) worked at tertiary hospitals or academic medical centers, and 60 (69.7%) had more than 5 years of endoscopic retrograde cholangiopancreatography experience. The preferred size criteria for large CBD stones were 15 mm (40.6%), 20 mm (31.3%), and 30 mm (4.6%). For managing of large CBD stones, endoscopic papillary large balloon dilation after endoscopic sphincterotomy was the most preferred technique (74.4%). When performing procedures in those with bleeding diathesis, 64 (74.4%) respondents favored endoscopic papillary balloon dilation (EPBD) alone or EPBD with small endoscopic sphincterotomy. Fifty-five respondents (63.9%) preferred the doubleguidewire technique when faced with difficult bile duct cannulation in patients with periampullary diverticulum. In surgically altered anatomies, cap-fitted forward viewing endoscopy (76.7%) and percutaneous transhepatic cholangioscopy (48.8%) were the preferred techniques for Billroth-II anastomosis and total gastrectomy with Roux-en-Y anastomosis, respectively. Most respondents showed unifying trends for the management of difficult CBD stones. The current practice patterns could be used as basic data for clinical quality improvements in the management of difficult CBD stones.