Randomised study of endoscopic biliary endoprosthesis versus duct clearance for bileduct stones in high-risk patients

Chopra, Kapil; Peters, Richard; O'Toole, P.A.; Williams, Simon G.; Gimson, Alexander; Lombard, Martin; Westaby, David

doi:10.1016/s0140-6736(96)06316-7

Cited by 102 publications

(61 citation statements)

References 11 publications

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“…It might be speculated that the initial relatively low rate of duct clearance reflects the rare use of mechanical lithotripsy, representing a low risk strategy for the management of bile duct stones in relatively high risk patients. Based on our previous experience 20 we have a low threshold for temporary placement of a pigtail endoprosthesis following the initial sphincterotomy with the aim of minimising the time period of the procedure, particularly in complicated cases such as acute cholangitis or gall stone pancreatitis or in the presence of severe comorbidity. This then allows the duct to be cleared in a much more controlled circumstance, a short period after recovery from the acute event.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic balloon dilatation versus endoscopic sphincterotomy for the removal of bile duct stones: a prospective randomised trial

Vlavianos

Chopra²,

Mandalia³

et al. 2003

Gut

113

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Background: Endoscopic balloon dilatation (EBD) of the sphincter of Oddi has been proposed as an alternative therapy with possible advantages, as compared with endoscopic sphincterotomy (ES), for removal of bile duct stones. Patients and methods: In a randomised study, we compared the efficacy and complication rate of the two techniques in 202 patients with common bile duct stones. Patients were followed up for 12 months. Results: A total of 103 patients were randomised to the EBD group and 99 to the ES group. Overall duct clearance was 87.1% and did not differ between the two groups (EBD 87.4%; ES 86.9%). The complication rate at 24 hours was 6.8% in the EBD group and 3.0% in the ES group (NS). Complications during follow up were 11.7% and 15.2% respectively (NS). A multivariate logistic regression analysis showed only the size of the largest stone to be predictive of success for either technique. Conclusion: Endoscopic balloon dilatation offers no significant advantage over the well established technique of endoscopic sphincterotomy for the removal of bile duct stones.

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Section: Discussionmentioning

confidence: 99%

Endoscopic balloon dilatation versus endoscopic sphincterotomy for the removal of bile duct stones: a prospective randomised trial

Vlavianos

Chopra²,

Mandalia³

et al. 2003

Gut

113

View full text Add to dashboard Cite

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“…Although patients for whom endoscopic removal of CBDS is likely to be dif cult should preferably undergo open surgery ; choledochotomy in elderly patients is reportedly associated with signi cant mortality, a positive rate of blood culture, and a prolonged hospital stay compared with young patients 9 . Hence, long-term biliary stent placement is used to treat some elderly patients in whom endoscopic removal of CBDS is dif cult 3 ; this procedure is reportedly useful in patients at a later stage and with a short life expectancy [10][11] . However, De Palma et al found that stent placement was not problem free in 40% 41% of patients followed up for a period of 117 days after biliary stenting 12 .…”

Section: Discussionmentioning

confidence: 99%

Safety and Utility of Endoscopic Removal of Common Bile Duct Stones in the Elderly

Ishii

Kitamura

Yamamiya

et al. 2014

Showa Univ J Med Sci

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: We investigated the safety and utility of endoscopic removal of common bile duct stones CBDS in the elderly. In all, 253 patients with CBDS who underwent endoscopic retrograde cholangiopancreatography ERCP between January 2007 and December 2011 at Showa University Hospital were evaluated retrospectively. The median age of the patients was 75 years ; thus, we divided patients into two groups, those aged ≥ 75 years Group A ; n 134 and those aged 75 years Group B ; n 119 . Patients in Group A had signi cantly higher rates of endoscopic sphincterotomy in palliative ERCP 24.8% vs. 10.7% ; p 0.008 and palliative removal of CBDS 34.8% vs. 20.9% ; p 0.015 than patients in Group B. However, the median dose of unitrazepam was signi cantly lower for patients in Group A than Group B 1 vs. 1.4 mg, respectively ; p 0.001 . The rate of use of pentazocine 18.5% vs. 54.7% ; p 0.001 and scopolamine butylbromide 6.2% vs. 23.9% ; p 0.01 was signi cantly lower in Group A patients, whereas the use of glucagon was significantly higher in this group 43.8 vs. 15.4% ; p 0.001 . There were no signi cant differences in the rate of successful endoscopic removal of CBDS, treatment time, complications, and the recurrence of CBDS between the two groups. Endoscopic removal of CBDS in the elderly is a safe procedure with good outcomes if the appropriate treatment is selected.

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“…In the majority of retained CBDS after ERCP, plastic stents are the most employed temporizing measure (11)(12)(13)(14)(15)(16)(17)(18)(19). This solution is good in the first months after the index ERCP, but in the long term, there can be major complications such as cholangitis (20).…”

Section: Discussionmentioning

confidence: 99%

Fully covered self-expanding metal stents in the management of difficult common bile duct stones

García-Cano¹,

Reyes-Guevara

Martínez-Pérez

et al. 2013

Rev. esp. enferm. dig.

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Background and objectives: plastic biliary stents are often used after an ERCP session without complete common bile duct stones (CBDS) extraction. Sometimes, the volume of biliary drainage with these stents may be insufficient. We present our experience with the use of fully covered self-expanding metal stents (FCSEMS) in the setting of incomplete CBDS extraction.Patients and methods: after an ERCP session with difficult CBDS not completely removed, biliary FCSEMS (Wallflex) were inserted in some patients when it was deemed that biliary sphincterotomy and a single plastic stent would not provide an adequate drainage.Results: a retrospective study was performed. Biliary FCSEMS were inserted in 29 patients, mean age 81 years. CBDS could not be extracted through a biliary sphincterotomy due to its large size (n = 18) or because of the presence of inflammatory distal strictures (n = 11). The greatest biliary drainage with shortest ERCP time was considered mandatory due to clinical instability of patients and/or poor tolerance to conscious sedation administered by the endoscopist. Successful biliary drainage was obtained in all cases. FCSEMS were removed after a median of 199.5 days in 16 patients with a complete CBDS extraction in 15 (93.7%). FCSEMS were not removed in the remaining 13 patients due to their clinical condition, and a wait-and-see strategy was undertaken.Conclusions: in selected cases, utilization of removable FCSEMS can be a good option for a quick and adequate biliary drainage in the setting of difficult CBDS. Because of the higher cost of these stents its use needs to be individualized.Key words: ERCP. Difficult common bile duct stones. Biliary plastic stents. Fully covered self-expanding metal stents. INTRODUCTIONFor nearly 40 years endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy has been the treatment of choice to remove common bile duct stones (CBDS). Since 2003, biliary sphincterotomy balloon dilation or sphincteroplasty is used for difficult cases with very good results (1). Complicated CBDS are usually those with more than 10 mm in diameter, multliple, impacted stones in the bile duct, concretions of hard consistency, peridiverticular situation of the ampulla, tortuosity or narrowing of the distal common bile duct and other conditions arising from the patient, like coagulation disorders (2).Plastic stents are the most used palliative method when after an ERCP session all CBDS cannot be removed. Friction between stones and stents produce the CBDS to fragment and shrink or become mud in a period of time from 3 to 6 months. Afterwards, the vast majority of CBDS can be removed fairly easily after a second ERCP session. For the remaining stones it is necessary to use certain forms of lithotripsy, such as mechanic lithotripsy. However, some CBDS may even continue without being extracted (3).Sometimes, ursodeoxycholic acid is added to plastic stents. As other solutions, such as terpene choleretic, they have the property to make more soluble cholesterol, ca...

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Randomised study of endoscopic biliary endoprosthesis versus duct clearance for bileduct stones in high-risk patients

Cited by 102 publications

References 11 publications

Endoscopic balloon dilatation versus endoscopic sphincterotomy for the removal of bile duct stones: a prospective randomised trial

Endoscopic balloon dilatation versus endoscopic sphincterotomy for the removal of bile duct stones: a prospective randomised trial

Safety and Utility of Endoscopic Removal of Common Bile Duct Stones in the Elderly

Fully covered self-expanding metal stents in the management of difficult common bile duct stones

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