{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T09:08:37Z","timestamp":1789549717977,"version":"build-2803163510"},"reference-count":30,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background: Choledocholithiasis is a common cause of biliary obstruction and may lead to acute cholangitis, pancreatitis, and other serious complications. Despite the widespread use of endoscopic retrograde cholangiopancreatography (ERCP), data describing the clinical profile and management of patients with choledocholithiasis in Romania remain limited. Objectives: This study aimed to describe demographic characteristics, diagnostic work-up, procedural characteristics of ERCP, microbiological findings, and early clinical outcomes of patients with choledocholithiasis undergoing ERCP at a high-volume tertiary referral center. Methods: We conducted a retrospective, observational, single-center cohort study of adults with confirmed choledocholithiasis who underwent ERCP between January 2021 and September 2025. During the study period, 2514 ERCP procedures were performed at our center for all indications, of which 631 unique patients with choledocholithiasis fulfilled the eligibility criteria and were included in the final cohort. Demographic characteristics, comorbidities, clinical presentation, laboratory findings, imaging results, ERCP-related variables, and early procedural outcomes were analyzed descriptively. Results: The cohort included 631 patients with a median age of 68 years (IQR 56\u201377), and 59.9% were women. Abdominal pain (59.3%) and jaundice (48.2%) were the most common presenting symptoms. Acute cholangitis was present in 57.7% of patients; among these patients, severity according to the Tokyo Guidelines 2018 was mild in 52.7%, moderate in 10.7%, and severe in 36.6%. Computed tomography was the most frequent imaging modality confirming the diagnosis (42.5%), followed by magnetic resonance cholangiopancreatography (30.7%) and ultrasonography (26.8%). Median common bile duct diameter was 14 mm and median stone diameter was 7.9 mm; multiple stones or sludge were present in 56.7%. Difficult cannulation occurred in 10.8% of patients, mechanical lithotripsy in 19.5%, biliary stent placement in 18.9%, and post-ERCP pancreatitis in 10.8%. Intraprocedural bleeding occurred in 4.9% of patients, while post-ERCP bleeding occurred in 1.9% and no perforations were recorded. In-hospital mortality occurred in 2 patients (0.3%). Bile cultures were obtained in 52 patients (8.3%), of which 37 (71.2%) yielded bacterial growth, with Escherichia coli being the most frequently isolated microorganism. Conclusions: This study provides real-world evidence on the epidemiology, diagnostic evaluation, ERCP management, and early outcomes of choledocholithiasis in a Romanian tertiary referral center.<\/jats:p>","DOI":"10.3390\/diseases14090340","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T07:58:59Z","timestamp":1789545539000},"page":"340","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Characteristics, ERCP Management, and Early Adverse Events Among Patients with Choledocholithiasis at a Romanian Tertiary Referral Center: A Retrospective Cohort"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6000-500X","authenticated-orcid":false,"given":"Cristina","family":"Angelescu","sequence":"first","affiliation":[{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, 020125 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7282-5189","authenticated-orcid":false,"given":"Ioana Anca","family":"B\u0103d\u0103r\u0103u","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2607-8653","authenticated-orcid":false,"given":"Radu Bogdan","family":"Mateescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, 020125 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1136\/gutjnl-2016-312317","article-title":"Updated Guideline on the Management of Common Bile Duct Stones (CBDS)","volume":"66","author":"Williams","year":"2017","journal-title":"Gut"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1016\/j.gie.2011.04.012","article-title":"The Role of Endoscopy in the Management of Choledocholithiasis","volume":"74","author":"Maple","year":"2011","journal-title":"Gastrointest. Endosc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1586","DOI":"10.1016\/j.cgh.2024.01.051","article-title":"Global Epidemiology of Gallstones in the 21st Century: A Systematic Review and Meta-Analysis","volume":"22","author":"Wang","year":"2024","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_4","first-page":"632","article-title":"Choledocholithiasis: A Literature Review","volume":"24","author":"Rizky","year":"2024","journal-title":"J. Biol. Trop."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.4240\/wjgs.v16.i4.1130","article-title":"Burden of Gallstone Disease in the United States Population: Prepandemic Rates and Trends","volume":"16","author":"Ruhl","year":"2024","journal-title":"World J. Gastrointest. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1055\/a-0862-0346","article-title":"Endoscopic Management of Common Bile Duct Stones: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"51","author":"Manes","year":"2019","journal-title":"Endoscopy"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1055\/a-1170-4847","article-title":"Diagnosing Choledocholithiasis: Better to Be European or American?","volume":"52","author":"Barthet","year":"2020","journal-title":"Endoscopy"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1016\/j.gie.2018.10.001","article-title":"ASGE Guideline on the Role of Endoscopy in the Evaluation and Management of Choledocholithiasis","volume":"89","author":"Buxbaum","year":"2019","journal-title":"Gastrointest. Endosc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1111\/den.14294","article-title":"Incidence of Adverse Event Associated with Endoscopic Retrograde Cholangiopancreatography in the Current Era: Pursuit of a Lower Incidence of Postendoscopic Retrograde Cholangiopancreatography Pancreatitis","volume":"34","author":"Kin","year":"2022","journal-title":"Dig. Endosc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"144","DOI":"10.23736\/S2724-5985.21.02876-X","article-title":"Endoscopic Management of Difficult Common Bile Duct Stones","volume":"68","author":"Dollhopf","year":"2022","journal-title":"Minerva Gastroenterol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"7863","DOI":"10.1007\/s00464-022-09662-4","article-title":"EAES Rapid Guideline: Updated Systematic Review, Network Meta-Analysis, CINeMA and GRADE Assessment, and Evidence-Informed European Recommendations on the Management of Common Bile Duct Stones","volume":"36","author":"Boni","year":"2022","journal-title":"Surg. Endosc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1053\/j.gastro.2024.10.033","article-title":"Adverse Events Associated With Endoscopic Retrograde Cholangiopancreatography: Systematic Review and Meta-Analysis","volume":"168","author":"Bishay","year":"2025","journal-title":"Gastroenterology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.1016\/j.cgh.2024.11.014","article-title":"Predictors of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Comprehensive Systematic Review and Meta-Analysis","volume":"23","author":"Beran","year":"2025","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.gie.2023.05.045","article-title":"Impact of Center and Endoscopist ERCP Volume on ERCP Outcomes: A Systematic Review and Meta-Analysis","volume":"98","author":"Papaefthymiou","year":"2023","journal-title":"Gastrointest. Endosc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1055\/a-1075-4080","article-title":"ERCP-Related Adverse Events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"52","author":"Dumonceau","year":"2020","journal-title":"Endoscopy"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"goae010","DOI":"10.1093\/gastro\/goae010","article-title":"Variability of Bile Bacterial Profiles and Drug Resistance in Patients with Choledocholithiasis Combined with Biliary Tract Infection: A Retrospective Study","volume":"12","author":"Zhang","year":"2024","journal-title":"Gastroenterol. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1055\/a-1790-1314","article-title":"Microbiology of Bile Aspirates Obtained at ERCP in Patients with Suspected Acute Cholangitis","volume":"54","author":"Gromski","year":"2022","journal-title":"Endoscopy"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Lagouvardou, E., Martines, G., Tomasicchio, G., Laforgia, R., Pezzolla, A., and Caputi Iambrenghi, O. (2022). Laparo-Endoscopic Management of Chole-Choledocholithiasis: Rendezvous or Intraoperative ERCP? A Single Tertiary Care Center Experience. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.938962"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1002\/jhbp.512","article-title":"Tokyo Guidelines 2018: Diagnostic Criteria and Severity Grading of Acute Cholangitis (with Videos)","volume":"25","author":"Kiriyama","year":"2018","journal-title":"J. Hepato-Biliary-Pancreat. Sci."},{"key":"ref_20","unstructured":"Pfleger, R. (2026, July 31). Revised Atlanta Classification of Acute Pancreatitis|Radiology Reference Article|Radiopaedia.Org. Available online: https:\/\/radiopaedia.org\/articles\/revised-atlanta-classification-of-acute-pancreatitis-2."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.gie.2009.10.027","article-title":"A Lexicon for Endoscopic Adverse Events: Report of an ASGE Workshop","volume":"71","author":"Cotton","year":"2010","journal-title":"Gastrointest. Endosc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"121","DOI":"10.33545\/surgery.2022.v6.i2b.903","article-title":"A Clinical Study on the Presentation and Management of Choledocholithiasis in a Tertiary Care Center","volume":"6","author":"Devasia","year":"2022","journal-title":"Int. J. Surg. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1080\/00365521.2018.1430255","article-title":"Clinical Applicability of Tokyo Guidelines 2018\/2013 in Diagnosis and Severity Evaluation of Acute Cholangitis and Determination of a New Severity Model","volume":"53","author":"Gomes","year":"2018","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S971","DOI":"10.1016\/j.hpb.2021.08.647","article-title":"Validation of Tokyo Guidelines 2018 for Cholangitis in an Australian Cohort","volume":"23","author":"Chew","year":"2021","journal-title":"HPB"},{"key":"ref_25","first-page":"5","article-title":"Post ERCP Complications Based on the Severity of Acute Cholangitis According to Tokyo Guideline Staging 2018","volume":"4","author":"Gharbi","year":"2020","journal-title":"Hepatol. Pancreat. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1007\/s10620-022-07424-9","article-title":"Management of Difficult Choledocholithiasis","volume":"67","author":"Podboy","year":"2022","journal-title":"Dig. Dis. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1055\/s-0042-108641","article-title":"Papillary Cannulation and Sphincterotomy Techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline","volume":"48","author":"Testoni","year":"2016","journal-title":"Endoscopy"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1872","DOI":"10.1007\/s10620-024-08289-w","article-title":"Bile Culture May Guide Antibiotic Stewardship in Acute Bacterial Cholangitis","volume":"69","author":"George","year":"2024","journal-title":"Dig. Dis. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Cozma, M.-A., G\u0103man, M.-A., Diaconu, C.C., Berger, A., Zerbib, F., and Mateescu, R.B. (2025). Microbial Profile and Antibiotic Resistance Patterns in Bile Aspirates from Patients with Acute Cholangitis: A Multicenter International Study. Antibiotics, 14.","DOI":"10.3390\/antibiotics14070679"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1016\/S2468-1253(21)00170-9","article-title":"Non-Steroidal Anti-Inflammatory Drugs, Intravenous Fluids, Pancreatic Stents, or Their Combinations for the Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Systematic Review and Network Meta-Analysis","volume":"6","author":"Akshintala","year":"2021","journal-title":"Lancet Gastroenterol. Hepatol."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/9\/340\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T08:45:30Z","timestamp":1789548330000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/9\/340"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":30,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["diseases14090340"],"URL":"https:\/\/doi.org\/10.3390\/diseases14090340","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]}}}