Analysis of Plastic Stents in the Treatment of Large Common Bile Duct Stones in 45 Patients

Fan, Zhimin; Hawes, Robert H.; Lawrence, Christopher; Zhang, Xiao; Zhang, Xiaofeng; Lv, Wen

doi:10.1111/j.1443-1661.2010.01065.x

Cited by 41 publications

(41 citation statements)

References 10 publications

(19 reference statements)

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“…For this reason, the use of longterm stenting should be limited to patients with a limited life expectancy. However, it has been reported that longterm stenting was effective in reducing the size of stones refractory to mechanical lithotripsy, and that complete elimination was achieved in 73.7-95.6% of cases when stone removal procedures were repeated after 3-6 months [135][136][137][138][139]. Even in patients given stents because stone removal had been difficult, complete stone removal may be achievable on retreatment; therefore reattempted stone removal is useful.…”

Section: Strength Of Recommendation (Agreement Rate): 2 (100%) Evidementioning

confidence: 99%

Evidence-based clinical practice guidelines for cholelithiasis 2016

Tazuma

Unno²,

Igarashi³

et al. 2016

J Gastroenterol

209

178

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Cholelithiasis is one of the commonest diseases in gastroenterology. Remarkable improvements in therapeutic modalities for cholelithiasis and its complications are evident. The Japanese Society of Gastroenterology has revised the evidence-based clinical practice guidelines for cholelithiasis. Forty-three clinical questions, for four categories-epidemiology and pathogenesis, diagnosis, treatments, and prognosis and complications-were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This article preferentially describes the clinical management of cholelithiasis and its complications. Following description of the diagnosis performed stepwise through imaging modalities, treatments of cholecystolithiasis, choledocholithiasis, and hepatolithiasis are introduced along with a flowchart. Since there have been remarkable improvements in endoscopic treatments and surgical techniques, the guidelines ensure flexibility in choices according to the actual clinical environment. The revised clinical practice guidelines are appropriate for use by clinicians in their daily practice.

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Section: Strength Of Recommendation (Agreement Rate): 2 (100%) Evidementioning

confidence: 99%

Evidence-based clinical practice guidelines for cholelithiasis 2016

Tazuma

Unno²,

Igarashi³

et al. 2016

J Gastroenterol

209

178

View full text Add to dashboard Cite

show abstract

“…In this study, we reported 86 % of the patients had successful stone removal after the second ERCP procedure. Among the factors that may contribute to this success is continuous friction between the stent and the stones caused by respiration and other biliary contractions, which facilitated of stone disintegration and reduced stone size [12]. Since increased friction may enhance this process, insertion of two stents was suggested to facilitate stone fragmentation [13].…”

Section: Discussionmentioning

confidence: 99%

“…57.5 % had a single bile duct stone, and the median diameter was 15 mm (7-30). The most commonly placed stents was 7 [5][6][7][8][9][10][11][12] cm in length and 10 [7][8][9][10] Fr in diameter. The median interval between the procedures was 2 (1-28) months (Table 1), and 90 % (n = 39) of the procedures were performed within 3 months.…”

Section: Characteristics Of the Patientsmentioning

confidence: 99%

Do not rush for surgery; stent placement may be an effective step for definitive treatment of initially unextractable common bile duct stones with ERCP

et al. 2015

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“…However, the combination of EPLBD with limited EST provided spacious opening of the bile duct, reducing the need for mechanical lithotripsy (4.7% vs 7.9%, P < 0.05) in our study, which is consistent with previous reports [31] . For patients with difficult stones that are not suitable for extraction at the first attempt, the temporary placement of a stent might be an alternative method, and the plastic stents are able to fragment large CBD stones [35,36] . Pancreatitis is one of the most feared post-ERCP complications and occurs in 5%-19.8% of patients after EPBD [26] .…”

Section: Resultsmentioning

confidence: 99%

Small sphincterotomy combined with endoscopic papillary large balloon dilationvssphincterotomy alone for removal of common bile duct stones

Guo¹,

Meng²,

Duan³

et al. 2014

WJG

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AIM:To evaluate the efficacy and safety of endoscopic papillary large diameter balloon dilation (EPLBD) following limited endoscopic sphincterotomy (EST) and EST alone for removal of large common bile duct (CBD) stones. METHODS:We retrospectively compared EST + EPLBD (group A, n = 64) with EST alone (group B, n = 89) for the treatment of large or multiple bile duct stones. The success rate of stone clearance, procedure-related complications and incidents, frequency of mechanical lithotripsy use, and recurrent stones were recorded. RESULTS:There was no statistically significant difference between the two groups regarding periampullary diverticula (35.9% vs 34.8%, P > 0.05), pre-cut sphincterotomy (6.3% vs 6.7%, P > 0.05), size (12.1 ± 2.0 mm vs 12.9 ± 2.6 mm, P > 0.05) and number (2.2 ± 1.9 vs 2.4 ± 2.1, P > 0.05) of stones or the diameters of CBD (15.1 ± 3.3 mm vs 15.4 ± 3.6 mm, P > 0.05). There were no cases of perforation, acute cholangitis, or cholecystitis in the two groups. The rate of bleeding and the recurrence of CBD stones were significantly lower in group A than in group B [1/64 (1.6%) vs 5/89 (5.6%), P < 0.05; 1/64 (1.6%) vs 6/89 (6.7%), P < 0.05, respectively]. CONCLUSION:EST + EPLBD is an effective and safe endoscopic approach for removing large or multiple CBD stones. Key words: Choledocholithiasis; Endoscopic retrograde cholangiopancreatography; Endoscopic papillary balloon dilation; Endoscopic sphincterotomy Core tip: Endoscopic papillary large diameter balloon dilation (EPLBD) after limited endoscopic sphincterotomy (EST) is an effective and safe endoscopic approach to remove large or multiple common bile duct stones. Compared with EST alone, the rate of bleeding and recurrence of CBD stones were significantly lower in the EST + EPLBD group (1.6% vs 5.6%, P < 0.05; 1.6% vs 6.7%, P < 0.05, respectively). While the rates of overall stone removal and stone removal in the first session (96.9% vs 94.4%, P > 0.05; 90.6% vs 88.8%, P > 0.05, respectively) and the rates of post-endoscopic retrograde cholangiopancreatography pancreatitis and hyperamylasemia were not significantly different between the two groups (4.7% vs 4.5%, P > 0.05; 10.9% vs 10.1%, P > 0.05, respectively).Guo SB, Meng H, Duan ZJ, Li CY. Small sphincterotomy combined with endoscopic papillary large balloon dilation vs sphincterotomy alone for removal of common bile duct stones. World J Gastroenterol 2014; 20(47): 17962-17969 Available from: URL:

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Analysis of Plastic Stents in the Treatment of Large Common Bile Duct Stones in 45 Patients

Abstract: Plastic biliary stenting may fragment common bile duct stones and decrease stone sizes. This is an effective and feasible method to clear large or difficult common bile duct stones.

Cited by 41 publications

References 10 publications

Evidence-based clinical practice guidelines for cholelithiasis 2016

Evidence-based clinical practice guidelines for cholelithiasis 2016

Do not rush for surgery; stent placement may be an effective step for definitive treatment of initially unextractable common bile duct stones with ERCP

Small sphincterotomy combined with endoscopic papillary large balloon dilationvssphincterotomy alone for removal of common bile duct stones

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