Endoscopic Sphincterotomy Plus Endoprostheses in the Treatment of Large or Multiple Common Bile Duct Stones

Abstract

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.

Effectiveness and safety of biliary stenting in the management of difficult common bile duct stones in elderly patients

“…Indeed, no stones were detected in one patient in each group at the second ERCP. Other studies also showed similar results (16,20,22).…”

“…Therefore, we considered that the results might be only slightly affected by stent migration. It is postulated that movements of the stone in the dilated duct promote the extrusion of the stent into the duodenum (22,25). The optimal type of stent has not yet been ascertained, although previous studies demonstrated that a pigtail stent may provide a lower risk of migration, cholangitis and perforation (16,17).…”

“…Also, prevention of stone impaction at the ampulla of Vater facilitates drainage after biliary stenting. Furthermore, polygonal stones may become more rounded after a period of friction and achieve a higher possibility of spontaneous passage (22). Indeed, no stones were detected in one patient in each group at the second ERCP.…”

“…The rate of successful removal declines with increasing sizes of the stone (22). Moreover, many patients with difficult CBD stones are of an older age (≥65 years) and/ or have severe associated diseases.…”

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

“…In addition, stent placement may [15]. No evidence of stones was seen in many cases during the second ERCP performed after several months, meaning that spontaneous passage of stones from the bile duct has occurred [14,16]. In this study, the second ERCP revealed that 23 % of stented patients had spontaneous stone passage.…”