Endoscopic Retrograde Cholangiopancreatography for Choledocholithiasis: Clinical Outcomes and Predictors of Complications

Background Common bile duct (CBD) stones are a frequent cause of biliary obstruction and may lead to life-threatening complications such as cholangitis, pancreatitis, and obstructive jaundice if not promptly managed. Endoscopic retrograde cholangiopancreatography (ERCP) has largely replaced open and laparoscopic bile duct exploration as the preferred therapeutic approach due to its minimally invasive nature, shorter hospital stay, and high efficacy. However, its success and safety depend on multiple clinical and procedural factors that require evaluation in local settings. Objective This study aims to evaluate the outcomes of ERCP for CBD stones in terms of efficacy, complications, and recurrence and to identify factors associated with post-ERCP adverse events. Methods This retrospective observational study was conducted at Akhtar Saeed Trust Hospital, Lahore, Pakistan, from January 2022 to January 2025, including 129 patients who underwent ERCP for suspected or confirmed CBD stones. Demographic, clinical, and procedural data were analyzed. Descriptive statistics were calculated for continuous variables (mean ± SD) and categorical variables (n, %). Comparative analyses between patients with and without complications were performed using an independent-sample t-test, Chi-square, or Fisher's exact test, and binary logistic regression was applied to determine predictors of complications. A p-value < 0.05 was considered statistically significant. Results The mean age of patients was 52.6 ± 13.4 years, with 76 (58.9%) females. The most common presenting symptom was abdominal pain, 91 (70.5%), followed by jaundice, 66 (51.2%). Complete stone clearance was achieved in 116 patients (89.9%) during the first ERCP session. Post-ERCP complications occurred in 17 patients (13.2%), most commonly pancreatitis in nine patients (7.0%), bleeding in four (3.1%), cholangitis in three (2.3%), and perforation in one patient (0.8%). Multiple stones were significantly associated with complications (OR = 2.89, 95% CI = 1.05-7.98, p = 0.041), and a hospital stay of more than five days was strongly predictive of adverse outcomes (OR = 6.12, 95% CI = 1.98-18.9, p = 0.002). No procedure-related mortality occurred, and recurrence of CBD stones was observed in seven (5.4%) cases during follow-up. Conclusion ERCP is a highly effective and safe therapeutic modality for CBD stones, providing high clearance rates with acceptable complications and no mortality. The presence of multiple stones and prolonged hospitalization were associated with increased risk of adverse events. Outcomes were influenced by stone size, number, and complexity, highlighting the importance of individualized patient assessment and careful procedural planning. ERCP continues to serve as the cornerstone of choledocholithiasis management, offering shorter hospital stays, faster recovery, and lower morbidity compared to surgical alternatives.