Temporary use of an accuflex stent for unextractable common bile duct stones

Abstract

Endoscopic management has become the main therapeutic approach for the extraction of common bile duct (CBD) stones, and successful removal can be achieved in 80-90% patients using conventional balloon and basket techniques. However, if it is difficult to completely fragment a stone, or to clear the CBD, which may occur for a variety of reasons, the therapeutic problem will remain. When bile duct stones can not be removed, a viable management option is to place a biliary stent to ensure drainage. However, recent studies of long-term biliary stenting, with a plastic stent, showed a relatively high rate of morbidity and mortality. We report an alternative, unique treatment for unextractable common bile duct stones, using the temporal placement of an expandable metallic stent (EMS) to facilitate passage of fragments through the papilla.

Complex biliary stones: treatment with removable self-expandable metal stents: a new approach (with videos)

“…Based on previous use, it can be hypothesized that CSEMSs could have an advantage over plastic stents in improving subsequent duct clearance. [18][19][20] Our aim was to characterize the efficacy and safety of temporary placement of CSEMSs for cases of complex biliary stones.…”

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

“…Biochemical changes which reduce stonepromoting factors after stenting may also facilitate stone dissolution [6,14]. 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].…”

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

“…Temporary use of a self-expanding metal stent for un-extractable BD stones was first reported in 2000 13. FC-SEMS have greater radial force than plastic stents; therefore, theoretically, they may be more successful in fragmenting the stone(s) and/or dilating the papilla.…”

“…[4][5][6][7][8][9][10][11][12] Temporary use of a self-expanding metal stent for un-extractable BD stones was first reported in 2000. 13 FC-SEMS have greater radial force than plastic stents; therefore, theoretically, they may be more successful in fragmenting the stone(s) and/or dilating the papilla. However, only a limited number of studies reported complete stone extraction rates after FC-SEMS placement, which ranged between 82 and 100%.…”