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ENDOSCOPIC SPHINCTEROTOMY PLUS ENDOPROSTHESES IN THE TREATMENT OF LARGE OR MULTIPLE COMMON BILE DUCT STONES
Author(s) -
HONG WANDONG,
ZHU QIHUAI,
HUANG QINGKE
Publication year - 2011
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/j.1443-1661.2010.01100.x
Subject(s) - medicine , endoscopic retrograde cholangiopancreatography , biliary stent , lithotripsy , common bile duct , stent , pancreatitis , bile duct , surgery , common bile duct stone , gallbladder stone , cholecystectomy
Background and Aim: Little information is available on the outcomes of endoscopic sphincterotomy plus biliary stent placement without stone extraction as primary therapy at initial endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of large or multiple common bile duct (CBD) stones. The aim of the present study was to study the effect of biliary stents and sphincterotomy as primary therapy for patients with choledocholithiasis. Methods: Patients with large (≥20 mm) or multiple (≥3) CBD stones were retrospectively studied. The patients underwent endoscopic sphincterotomy and placement of plastic stents in the bile duct without stone extraction at the initial ERCP. Three or more months later, a second ERCP was carried out and stone removal was attempted. Differences in stone size and the largest CBD diameter before and after stenting were compared. Stone clearance and complications were also evaluated. Results: 52 patients were enrolled. After a median of 124 days of biliary plastic stent placement the mean maximal stone diameter decreased from 16.6 mm to 10.0 mm ( P < 0.01). The mean CBD diameter also decreased from 15.3 mm to 11.5 mm ( P < 0.01). The total stone clearance at second ERCP was 94.2%, only 5.7% of which needed mechanical lithotripsy. Complications: pancreatitis in one (1.9%) at initial ERCP, cholangitis in two (3.8%) after 52 days and 84 days of placement of stent. No complications were recorded at second ERCP. Conclusions: Biliary plastic stents plus endoscopic sphincterotomy without stone extraction as primary therapy at initial ERCP is a safe and effective method in the management of large or multiple CBD stones.