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Background/Aim: Different endoscopic modalities are available for the extraction of common bile duct (CBD) stones. However, there is no clear consensus on the better therapeutic approach. Aim of the study was to analyze the effectiveness of endoscopic retrograde cholangiopancreatogram (ERCP) and endoscopic sphincterotomy (ES) and the role of ‘interim’ plastic biliary stent deployment in difficult pigmented CBD stones. Materials and methods: One hundred and sixty-three patients with CBD stone who underwent ERCP and ES between May 2006 and August 2010 were included in the study. Patients with incomplete clearance of stone underwent an ‘interim’ 10 cm 7 Fr size plastic stent. Approximately 3 weeks later, stone removal was attempted. Results: ERCP and ES with stone clearance were successful in 114 (69.9%) patients. The mean size of the stone was 1.5 cm (p < 0.0001). In 21.5% patients in whom ERCP and ES was not successful, stone retrieval was possible after plastic stent deployment after a median of 24 days. The median number and size of stones per patient was significantly reduced after biliary stenting compared with before [5 (3) vs 2 (1) (p < 0.0001)], [2.8 (1.5) vs 2 (1) (p < 0.001)], respectively. Conclusion: Plastic biliary stenting for difficult common bile stones becoming decrease in stone sizes. Unlike cholesterol stones, stent placement of 3 weeks was related with large and/or multiple stones becoming decrease in size and/or disappearing without unplanned events in pigment stones.

Endoscopic Management and Role of Interim Plastic Biliary Stenting in Large and Multiple Pigmented Common Bile Duct Stone