Study on the Effectiveness of Choledochoscopic Stone Extraction and Its Impact on Patient Complications

Background Choledocholithiasis is a common biliary tract disease that requires effective intervention. This study aimed to evaluate the effectiveness of transduodenal choledochoscopy stone extraction and analyze its impact on postoperative complications in a prospective cohort of patients. Methods A prospective study was conducted on 186 patients with choledocholithiasis who underwent transduodenal choledochoscopy stone extraction between January 2022 and December 2023. Patients were evaluated for operative success rate, stone clearance rate, and postoperative complications. Stone characteristics, technical aspects, quality of life outcomes, and cost-effectiveness were assessed. Follow-up was conducted for 6 months post-procedure. Results The overall stone clearance rate was 94.6% (176/186), with complete stone removal achieved in a single session in 82.8% of cases (154/186). Mean operation time was 45.3 ± 15.7 min. Basket extraction was the primary method (52.7%), followed by balloon extraction (24.2%) and mechanical lithotripsy (23.1%). Postoperative complications occurred in 11.8% of patients, including pancreatitis (3.2%), cholangitis (2.7%), bleeding (1.6%), and minor complications (4.3%). The stone recurrence rate during the 6-month follow-up period was 4.3%, with a mean time to recurrence of 4.2 ± 1.3 months. Multivariate analysis revealed that stone size >15 mm (OR: 2.34, 95% CI: 1.45-3.78, P < 0.001), multiple stones (OR: 1.89, 95% CI: 1.23-2.91, P = 0.003), and intrahepatic location (OR: 1.76, 95% CI: 1.12-2.77, P = 0.014) were independent risk factors for procedural failure. Quality of life scores showed significant improvement across all SF-36 domains ( P < 0.001). Mean procedure-related costs were $2845 ± 625, with additional costs of $986 ± 423 for managing complications. Conclusions Transduodenal choledochoscopy stone extraction demonstrates high effectiveness with acceptable complication rates. The technique proves particularly suitable for patients with stones smaller than 15 mm and shows advantages in terms of single-session success rates and long-term stone clearance. While initial costs and operator experience may pose challenges, reduced radiation exposure and lower need for re-intervention highlight its clinical value. While associated with higher initial costs, the procedure may be cost-effective due to reduced need for repeat interventions and improved quality of life outcomes. Careful patient selection based on stone characteristics and anatomical factors is crucial for optimal outcomes.