Abstract: Objective The aim of this study was to analyze failure reasons of endoscopic retrograde cholangiopancreatography (ERCP)and rescue therapy in patients with common bile duct stones(CBDS). Methods A total of 254 patients with CBDS were encountered in our hospitalbetween January 2020 and June 2023, and all underwent ERCP therapy. The operation was finished by attending surgeons in 102 cases, and by proficient surgeons in other 152 cases. Failure reasons was recorded, and remedial management measures included laparoscopic or open cholecystectomy, percutaneous transhepatic biliary drainage (PTCD), ERCP once again by proficient surgeions, or comprehensive internal therapy. Results There were no statistically significant differences as respect to ages, gender, common bile duct diameters, stone sizes and concomitant gallbladder stones between patients treated by attending or proficient surgeons (P>0.05); in patients with selective operation, successful rate of ERCP by proficient surgeons was 82.2%, much higher than 72.5%(P<0.05) by attending surgeons, while there was no significant difference as respect to successful rate of ERCP in patients with emergent operation by the two group surgeons (8.6% vs. 8.8%, P>0.05);ERCP failed in 33 cases (13.0%) in our series, the main reasons arising from invisible duodenal papilla, including pyloric stenosis and duodenal stenosis, and from visible duodenal papilla, including juxtapapillary diverticulum, small papilla, edema of papilla, space-occupying lesions in papilla and bile duct stenosis, and there was no significant difference respect to ERCP failure reasons between attending and proficient surgeons(P>0.05); of 33 patients with failed ERCP, ERCP was tried again by proficient surgeons and successful in 7 patients (21.2%),laparoscopic or open cholecystectomy performed in 9 cases (27.3%), including palliative operation in 6 cases (66.7%)and radical surgery in 3 cases(33.3%), 2 patients (6.1%) with chronic pancreatitis and pseudocyst of the pancreas recovered, PTCD was carried out in 11 cases (33.3%), clinical symptoms relieved, and one of them recovered after open surgery, and comprehensive internal supporting therapy was administered in 4 cases (12.1%), and jaundice and abdominal pain disappeared in two (50.0%)of them. Conclusion ERCP is a complicated operation, and should be performed by proficient surgeons. We vigorously recommend preparation of rescue plans for failed patients for improvement of clinical outcomes.

Key words: Common bile duct stones, Endoscopic retrograde cholangiopancreatography, Reasons for failure, Remedial measures, Therapy