Retained common bile duct stones after endoscopic sphincterotomy: temporary and longterm treatment with biliary stenting.

Maxton, D. G.; Tweedle, D. E. F.; Martin, D. F.

doi:10.1136/gut.36.3.446

Cited by 88 publications

(46 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Stones were extracted after a median of 63 d, and the repeated procedures achieved complete duct clearance in 25 (89%) of the patients. Similar results have also been reported by Maxton et al [21] and Jain et al [22] . The most common complications we observed were cholangitis and pancreatitis (14.3% and 4.8%, respectively).…”

Section: Discussionsupporting

confidence: 91%

Failure of sequential biliary stenting for unsuccessful common bile duct stone removal

Prachayakul

Aswakul²

2013

WJGE

View full text Add to dashboard Cite

AIM:To determine the factors associated with the failure of stone removal by a biliary stenting strategy. METHODS:We retrospectively reviewed 645 patients with common bile duct (CBD) stones who underwent endoscopic retrograde cholangiography for stone removal in Siriraj GI Endoscopy center, Siriraj Hospital from June 2009 to June 2012. A total of 42 patients with unsuccessful initial removal of large CBD stones that underwent sequential biliary stenting were enrolled in the present study. The demographic data, laboratory results, stone characteristics, procedure details, and clinical outcomes were recorded and analyzed. In addition, the patients were classified into two groups based on outcome, successful or failed sequential biliary stenting, and the above factors were compared. RESULTS:Among the initial 42 patients with unsuccessful initial removal of large CBD stones, there were 37 successful biliary stenting cases and five failed cases. Complete CBD clearance was achieved in 88.0% of cases. The average number of sessions needed before complete stone removal was achieved was 2.43 at an average of 25 wk after the first procedure. Complications during the follow-up period occurred in 19.1% of cases, comprising ascending cholangitis (14.3%) and pancreatitis (4.8%). The factors associated with failure of complete CBD stone clearance in the biliary stenting group were unchanged CBD stone size after the first biliary stenting attempt (10.2 wk) and a greater number of endoscopic retrograde cholangio-pancreatography sessions performed (4.2 sessions). CONCLUSION:The sequential biliary stenting is an effective management strategy for the failure of initial large CBD stone removal. Key words: Endoscopic retrograde cholangiography; Common bile duct stone; Biliary stenting; Large common bile duct stone; Biliary stenting failure Core tip: This study was a retrospective review of 42 patients who underwent sequential biliary stenting following a failed removal of a large common bile duct stone by endoscopic retrograde cholangiopancreatography. Complete common bile duct (CBD) clearance was achieved in 88% of the patients at 25 wk after the first procedure, while 19% reported complications. The common complications were cholangitis and pancreatitis. The factors associated with the failure of this strategy were unchanged CBD stone size at the second biliary stenting attempt, and more endoscopic retrograde cholangio-pancreatography sessions performed.Prachayakul V, Aswakul P. Failure of sequential biliary stenting for unsuccessful common bile duct stone removal. World J Gastrointest Endosc 2013; 5(6): 288-292 Available from: URL:

show abstract

Section: Discussionsupporting

confidence: 91%

Failure of sequential biliary stenting for unsuccessful common bile duct stone removal

Prachayakul

Aswakul²

2013

WJGE

View full text Add to dashboard Cite

show abstract

“…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.

View full text Add to dashboard Cite

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...

show abstract

“…Several previous studies have suggested that permanent biliary stenting may be a definitive therapy for endoscopically unextractable common duct stones in selected elderly patients who are poor surgical candidates. When biliary symptoms do recur, they can usually be treated conservatively with antibiotics, a prosthesis change, or both [2,13] . To the best of our knowledge, our case report represents the oldest in situ plastic biliary endoprosthesis ever reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Oldest biliary endoprosthesisin situ

Consolo¹

2013

WJGE

View full text Add to dashboard Cite

The advantages of endoscopic retrograde cholangiopancreatography over open surgery have made it the predominant method of treating patients with choledocholithiasis. After sphincterotomy, however, 10%-15% of common bile duct stones cannot be removed with a basket or balloon. The methods for managing "irretrievable stones" include surgery, mechanical lithotripsy, intraductal or extracorporeal shock wave lithotripsy and biliary stenting. The case presented was a referred 82-year-old Caucasian woman with a 7-year-old plastic biliary endoprosthesis in situ . To the best of our knowledge the examined endoprosthesis is the oldest endoprosthesis in situ reported in the literature. Endoscopic biliary endoprosthesis placement remains a simple and safe procedure for patients with stones that are difficult to manage by conventional endoscopic methods and for patients who are unfit for surgery or who are high surgical risks. To date no consensus has been reached regarding how long a biliary prosthesis should remain in situ . Long-term biliary stenting may have a role in selected elderly patients if stones extraction has failed because the procedure may prevent stones impaction and cholangitis.

show abstract

Retained common bile duct stones after endoscopic sphincterotomy: temporary and longterm treatment with biliary stenting.

Abstract: [446][447][448][449]

Cited by 88 publications

References 14 publications

Failure of sequential biliary stenting for unsuccessful common bile duct stone removal

Failure of sequential biliary stenting for unsuccessful common bile duct stone removal

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

Oldest biliary endoprosthesisin situ

Contact Info

Product

Resources

About