Dissolution of common bile duct stones

Motson, R. W.

doi:10.1002/bjs.1800680321

Cited by 21 publications

(5 citation statements)

References 43 publications

(13 reference statements)

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“…The corresponding figures in our study were 96.5% and 93.5%, respectively. In patients with retained calculi, alternative nonsurgical methods such as chemical dissolution therapy, flushing techniques, and percutaneous removal via T-tube tract carry success rates of only 20% to 50% and 70% to 80%, respectively [22][23][24][25][26], although some centers report 95% success rate of T-tube tract extraction [27][28][29]. Despite this mediocre outcome, such techniques have been advocated as primary procedures in patients with indwelling T-tubes [30].…”

Section: Discussionmentioning

confidence: 99%

Long‐Term Follow‐up after Endoscopic Treatment of Bile Duct Calculi in Cholecystectomized Patients

1996

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Endoscopic sphincterotomy (EST) is an established method for treatment of retained or recurrent common bile duct (CBD) calculi after cholecystectomy. Present experience shows that few patients have recurrent biliary tract complications, but follow-up periods are most often short. EST was performed in 147 patients with bile duct calculi and remote cholecystectomy in our department from 1981 to 1992. In 8 of 147 patients (5.4%) complete removal of calculi failed. A total of 135 patients with a median age of 71 years (range 24-96 years) were eligible for a follow-up of 23 to 153 months (median 86 months). Thirty-seven patients have died without recurrent symptoms (a recurrent stone was revealed at postmortem examination in one patient), and four patients (two with calculi and two with cholangiocarcinoma) died with recurrent symptoms from the biliary tract. Ninety-four patients are alive; and with the exception of two who have had cholangitis without or with post-EST stenosis, respectively, they are all symptom-free. Jaundice, cholangitis, and biliary pancreatitis prior to EST were the only factors that significantly (p = 0.006, Fisher's exact test) predicted late biliary complications after EST in patients with recurrent calculi. These findings confirm that endoscopic treatment of CBD calculi in cholecystectomized patients has a low long-term rate (5 of 135; 3.7%) of recurrent nonmalignant bile duct disease (three patients with CBD calculi and two with cholangitis).

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Section: Discussionmentioning

confidence: 99%

Long‐Term Follow‐up after Endoscopic Treatment of Bile Duct Calculi in Cholecystectomized Patients

1996

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“…(This stenosis is secondary to segmental choledochitis or an ex- ternal compression, generally due to inflammation of the head of the pancreas); (b) the incidence of CBD dilatation is high in elderly patients [36]; and (c) "primary" biliary stones result from the obstruction. Any procedure to remove the stones [1][2][3][4][5][6][7][8][9][10] has only transitory value as long as biliary stenosis is unresolved.…”

Section: Discussionmentioning

confidence: 99%

“…A multidisciplinary approach to biliary lithiasis, involving conservative methods, has awakened enthusiasm. These include methods such as the chemical dissolution of bile duct stones [1][2][3][4], less invasive technique of nonoperative instrumental extraction of retained bile duct stones [5][6], and duodenoscopic papillotomy [7][8][9][10]. None of these techniques is infallible or free of complications [11] and none has yet a long-term follow-up.…”

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confidence: 99%

Is choledochoduodenostomy in the treatment of stones in the common bile duct an obsolete technique?

1985

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The complex pathogenesis of bile duct stones, the anatomical properties of the biliary tree, the patient's age, associated diseases, as well as the technical devices available, may explain the great variety of procedures and preferences of different groups in the treatment of choledocholithiasis. Since no technique is infallible or free of complications, it seems unfair to argue that procedures whose efficacy has been proven by many authors are obsolete. This is the case of choledochoduodenostomy (CDS) in the treatment of common bile duct (CBD) stones. The complications associated with CDS, (ascending cholangitis, and “sump” syndrome) have been overemphasized and have led CDS to be rejected by many surgeons. Our experience with this technique is good and concurs with that of Madden and others.Data on 125 patients with CBD stones treated with CDS between 1968 and 1982 are analyzed. Sixty‐eight of them were female and the mean age was 61.4 years; 73.6% were more than 50 years old. There were frequent accompanying diseases, especially cardiovascular ones. More than half of the patients had a previous operation on the biliary tree. The duct diameter was always greater than 20 mm and it was frequently associated with stenosis of the distal choledochus. Floercken's technique of CDS was the most frequently used, after Kocher's maneuver had been performed. There was no intraoperative mortality. Postoperative mortality was 3.2% and is analyzed in detail. The incidence of postoperative complications was 42.4%. Most were septic complications or those ascribed to accompanying diseases. Late operative cholangitis was present in 1.6% of patients, comparable with reports of other authors. We encourage the use of CDS in the treatment of CBD stones provided that: (a) careful attention is paid to its clinical indications, considering that the patient may benefit from alternative techniques, for example, duodenoscopic papillotomy; and (b) choledochal dilatation is greater than 20 mm in diameter and the choledochal and duodenal walls are normal. We specifically recommend CDS as the primary operation for patients with “choledochal funnel syndrome.” The operation is simple, restores normal digestive function, and almost always resolves the problems of CBD stones in high‐risk patients.

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“…In a collected series of 91 patients treated with sodium cholate, stone disappearance was reported in only 60%. 27 Stone dissolution with sodium cholate has not become popular because of the limited success rate and the severe side-effects.…”

Section: Contact Dissolution Of Common Duct Gallstonesmentioning

confidence: 99%

Review article: dissolution of gallstones in the biliary tree

Summerfield

1989

Aliment Pharmacol Ther

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SUMMARY There are a variety of methods for dissolving gallstones in the biliary tree, which include oral therapy and direct contact dissolution. Cholesterol gallstones are most amenable to dissolution. Developments in non‐operative physical methods to remove gallstones (particularly endoscopic papillotomy and extracorporeal shock‐wave lithotripsy have diminished the use of chemical dissolution. However, in selected patients, there remains a place for chemical dissolution, but often in conjunction with the physical techniques.

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Dissolution of common bile duct stones

Cited by 21 publications

References 43 publications

Long‐Term Follow‐up after Endoscopic Treatment of Bile Duct Calculi in Cholecystectomized Patients

Long‐Term Follow‐up after Endoscopic Treatment of Bile Duct Calculi in Cholecystectomized Patients

Is choledochoduodenostomy in the treatment of stones in the common bile duct an obsolete technique?

Review article: dissolution of gallstones in the biliary tree

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