Fully Covered Metal Stents Safely Facilitate Extraction of Difficult Bile Duct Stones

Abstract

Background: Ten to 15% of the common bile duct (CBD) stones require advanced endoscopic extraction techniques during endoscopic retrograde cholangiopancreatography. The study aimed to evaluate the efficacy and safety of fully covered self-expandable metal stents (FC-SEMS) for facilitating the extraction of difficult bile duct stones.Methods: Patients who received FC-SEMS for the extraction of difficult CBD stones were retrospectively reviewed. Group 1 included patients with extrahepatic stones above a distal CBD stricture, Group 2 included patients with intrahepatic stones above a hilar stricture, and Group 3 included patients with complex stone (s) and no biliary stricture. Complete stone clearance rate and complications of FC-SEMS treatment were evaluated. Results:The study group included 33 procedures on 32 patients (mean age: 55 ± 17, 56.3% male). FC-SEMS was placed as a primary treatment in 15 (45.5%) procedures. Complete stone clearance was achieved in 84.6% of the procedures in Group 1, 100% in Group 2, and 87.5% in Group 3 (P = 0.23). Overall, complete stone clearance was achieved in 30 of the 33 procedures (90.9%). None of the patients developed pancreatitis, cholecystitis, or cholangitis. Stent migration occurred in 4 procedures (12.1%), and all were clinically insignificant.Conclusion: FC-SEMS is effective and safe for facilitating treatment of difficult bile duct stones.

Comparison of the clinical effects of dual-modality endoscopy and traditional laparotomy for the treatment of intra- and extrahepatic bile duct stones

“…Bile duct stones (BDSs) are calculi that occur in the hepatobiliary system and are etiologically related to cholestasis, bile duct infection, stenosis or obstruction, and the presence of foreign bodies in the bile duct[ 1 - 3 ]. Occurring in the digestive system, BDSs often do not heal spontaneously; moreover, intrahepatic BDSs can easily migrate to the common bile duct and become extrahepatic BDSs, which may progress to cirrhosis and even liver cancer[ 4 ].…”