Effect of Saline Irrigation in Reducing Choledocholithiasis Recurrence After ERCP

Study Overview
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Brief Summary
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In this prospective study, the investigators assessed the utility of intermittent saline irrigation in reducing the recurrent rate of choledocholithiasis after the endoscopic extraction for common bile duct stones, and it does not increase the rate of procedure-related complications.

Detailed Description
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In recent years, an endoscopic retrograde cholangiopancreatography (ERCP) is the golden standard procedure to remove the common bile duct stones(CBD). Nevertheless, it is reported that the recurrence rate of CBD stones is 4% to 24% after ERCP. The contributing factors were periampullar diverticulum, situ gallbladder, and incomplete CBD stone clearance. The main reason of stone recurrence is incomplete CBD stone clearance including remnant stone fragments themselves and tinny fragments can act as a nidus for further CBD stone growth. It is difficult to retrieve these fine fragments completely using conventional devices such as retrieval basket and ballon. Therefore, the investigators attempt to remove residual stone fragments by means of saline infusion. Saline irrigation has many advantages such as better effect and less side effect and no extra cost. It is reported that use intraductal ultrasonography (IDUS) to demonstrate residual CBD stones. However, IDUS has limited availability in clinical practice. The single-operator cholangioscopy (SOC)-system gains widespread acceptance because of its independent washing channels and direct viewing. The purpose of this study is to evaluate whether saline solution irrigation would decrease the recurrent rate of choledocholithiasis after endoscopy retrieval stones.

Official Title
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Effect of Intermittent Saline Irrigation in Reducing Choledocholithiasis Recurrence After ERCP

Conditions
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Stone - Biliary

Intervention / Treatment
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* Procedure: Saline irrigation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: With ERCP indications With mechanical lithotripsy during operation Exclusion Criteria: Unwillingness or inability to consent for the study Unstable vital signs Coagulation dysfunction (INR>1.5) and low peripheral blood platelet count (<50×10 ^9 / L) or using anti-coagulation drugs Prior surgery of Bismuth Ⅱ, Roux-en-Y and cholangiojejunostomy Preoperative coexistent diseases: acute pancreatitis, GI tract hemorrhage, severe liver disease (such as decompensated liver cirrhosis, liver failure and so on), septic shock Biliary-duodenal fistula confirmed during ERCP Pregnant women or breastfeeding

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Saline irrigation<br>CBD stone removal after routine ERCP procedure,100ml saline irrigation after a balloon occlusion cholangiogram confirming the absence of stones. | Procedure: Saline irrigation<br>* 100ml saline irrigation after CBD stone removal with routine ERCP procedure<br>|
| No Intervention: None saline irrigation<br>CBD stone removal after routine ERCP procedure, a balloon occlusion cholangiogram confirms the absence of stones. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants with Recurrence of CBD Stones | Number of Participants with stones detected by Magnetic resonance cholangiopancreatography, CT or US confirms CBD stone recurrence no matter symptomatic choledocholithiasis or not | 3 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants with Cholangitis | Temperature should be more than 38 ℃, with right upper abdominal pain, blood routine showing the total amount of the White Blood Cell (WBC), and the amount of polymorphonuclear neutrophil(PMN) are above normal | 3 years | 
| Number of Participants with Pancreatitis | Typical abdominal pain, with the level of serum amylase increasing at least 3 times of the normal range within 24 hours after surgery, and there are also radiographic evidence suggesting the shape of pancreas has changed | 3 years | 
| Number of Participants with Bleeding | Was defined as the clinical and endoscopic evidence of hemorrhage associated. with a decreasing the hemoglobin level >2 g/dl | 1 month | 
| Number of Participants with Perforation | Was defined as the presence of air or contrast in the retroperitoneal space | 1 month | 
| Procedure time of each case | From the moment the endoscope entered, to the moment withdraw the scope | 7 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cholangitis, ERCP, Common bile duct stone, Residual stone, Irrigation, Recurrence