Is the addition of choleretic agents in multiple double-pigtail biliary stents effective for difficult common bile duct stones in elderly patients? A prospective, multicenter study

Lee, Tae Hoon; Han, Joung Ho; Kim, Hong Ja; Park, Seon Mee; Park, Sang‐Heum; Kim, Sun‐Joo

doi:10.1016/j.gie.2011.03.005

Cited by 62 publications

(61 citation statements)

References 24 publications

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“…Conventional methods, including balloon or basket techniques, are often problematic when extracting large and/or multiple CBD stones (6,8). The rate of successful removal declines with increasing sizes of the stone (22).…”

Section: Discussionmentioning

confidence: 99%

“…The possible reasons may be as follows: primarily, insertion of double stents would increase surface friction between the stents and prompt more stone fragmentation than a single stent. Also, even if stent occlusion occurs, stents may still maintain continuous drainage of the bile duct via a "wicking" phenomenon, with bile flowing around and between the stents (8). Furthermore, the more efficient drainage caused by the insertion of double stents could reduce duodenobiliary reflux and prevent calcium bilirubinate from precipitating in the stents.…”

Section: Discussionmentioning

confidence: 99%

“…Alternative techniques include mechanical, extracorporeal, electrohydraulic, or laser lithotripsy as well as chemical dissolution (7). Although these interventions have been considered as effective therapeutic methods for removing CBD stones, they are timeconsuming and unavailable in some institutions (7,8). In addition, elderly patients, particularly those with severe comorbidities, cannot tolerate invasive endoscopic procedures of a long duration (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Huai²,

Sun³

2016

Turk J Gastroenterol

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Huai²,

Sun³

2016

Turk J Gastroenterol

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“…Many endoscopists prefer double pigtail stents because the straight ones can migrate more easily and if they are longer than 9 cm in length can cause duodenal perforation. In one study (21,22) it has been observed that simultaneously multiple pigtails insertion in not extracted CBDS, can improve bile drainage. However, several plastic stents insertion is more complex, takes longer and can obtain a smaller drainage volume than a single FCSEMS insertion.…”

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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“…Approximately 10% to 15% of CBD stones are difficult to remove using conventional endoscopic sphincterotomy and balloon/basket extraction techniques, including mechanical lithotripsy. Multiple or large CBD stones (> 20 mm in diameter), the presence of periampullary diverticula, narrowing or stricture of the distal CBD, limited sphincterotomy caused by small papillae and no visible intramural course of the CBD in the duodenal wall all influence the probability of successful stone extraction [4] . In such cases, temporary biliary stenting is a safe and effective bridge therapy.…”

Section: Discussionmentioning

confidence: 99%

Oldest biliary endoprosthesisin situ

Consolo¹

2013

WJGE

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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.

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Is the addition of choleretic agents in multiple double-pigtail biliary stents effective for difficult common bile duct stones in elderly patients? A prospective, multicenter study

Cited by 62 publications

References 24 publications

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

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

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

Oldest biliary endoprosthesisin situ

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