Endoscopic Management of the Difficult Bile Duct Stones: A Single Tertiary Center Experience

Bülent Ödemiş, Ufuk Barış Kuzu, Erkin Öztaş, Fatih Saygılı, Nuretdin Suna, Orhan Coskun, Adem Aksoy, Zeliha Sırtaş, Derya Arı, Yener Akpınar, Bülent Ödemiş, Ufuk Barış Kuzu, Erkin Öztaş, Fatih Saygılı, Nuretdin Suna, Orhan Coskun, Adem Aksoy, Zeliha Sırtaş, Derya Arı, Yener Akpınar

Abstract

Background. Most common bile duct (CBD) stones can be removed with standard techniques using endoscopic retrograde cholangiopancreatography (ERCP), but in some cases additional methods are needed. In this study we aimed to investigate the management of patients with difficult stones and the factors that affect the outcome of patients that have undergone periodic endobiliary stenting. Materials and Methods. Data of 1529 patients with naive papilla who had undergone ERCP with an indication of CBD stones was evaluated retrospectively. Stones that could not be removed with standard techniques were defined as "difficult stones." Cholangiograms of patients who had difficult stones were revised prospectively. Results. Two hundred and eight patients (13.6%) had difficult stones; 150 of these patients were followed up with periodic endobiliary stenting and successful biliary clearance was achieved in 85.3% of them. Both CBD (p < 0.001) and largest stone size (p < 0.001) were observed to be significantly reduced between the first and the last procedure. This difference was even more significant in successfully treated patients. Conclusions. Periodic endobiliary stenting can be used as an effective treatment for patients with difficult stones. Sizes of the CBD and of the largest stone are independent risk factors that affect the success rate.

Conflict of interest statement

The authors declare that there is no conflict of interests regarding the publication of this paper.

Figures

Figure 1
Figure 1
Design of the study population (ESWL: extracorporeal shock wave lithotripsy).

References

    1. McHenry L., Lehman G. Difficult bile duct stones. Current Treatment Options in Gastroenterology. 2006;9(2):123–132. doi: 10.1007/s11938-006-0031-6.
    1. Carr-Locke D. L. Difficult bile-duct stones: cut, dilate, or both? Gastrointestinal Endoscopy. 2008;67(7):1053–1055. doi: 10.1016/j.gie.2008.02.003.
    1. Hochberger J., Tex S., Maiss J., Hahn E. G. Management of difficult common bile duct stones. Gastrointestinal Endoscopy Clinics of North America. 2003;13(4):623–634. doi: 10.1016/s1052-5157(03)00102-8.
    1. Trikudanathan G., Navaneethan U., Parsi M. A. Endoscopic management of difficult common bile duct stones. World Journal of Gastroenterology. 2013;19(2):165–173. doi: 10.3748/wjg.v19.i2.165.
    1. Chan A. C. W., Ng E. K. W., Chung S. C. S., et al. Common bile duct stones become smaller after endoscopic biliary stenting. Endoscopy. 1998;30(4):356–359. doi: 10.1055/s-2007-1001282.
    1. Üsküdar O., Parlak E., Dışıbeyaz S., et al. Major predictors for difficult common bile duct stone. Turkish Journal of Gastroenterology. 2013;24(5):423–429. doi: 10.4318/tjg.2013.0511.
    1. Aslan F., Arabul M., Celik M., Alper E., Unsal B. The effect of biliary stenting on difficult common bile duct stones. Przeglad Gastroenterologiczny. 2014;9(2):109–115. doi: 10.5114/pg.2014.42507.
    1. Prachayakul V., Aswakul P. Failure of sequential biliary stenting for unsuccessful common bile duct stone removal. World Journal of Gastrointestinal Endoscopy. 2013;5(6):288–292. doi: 10.4253/wjge.v5.i6.288.
    1. Kim H. J., Choi H. S., Park J. H., et al. Factors influencing the technical difficulty of endoscopic clearance of bile duct stones. Gastrointestinal Endoscopy. 2007;66(6):1154–1160. doi: 10.1016/j.gie.2007.04.033.
    1. Katanuma A., Maguchi H., Osanai M., Takahashi K. Endoscopic treatment of difficult common bile duct stones. Digestive Endoscopy. 2010;22(1):S90–S97. doi: 10.1111/j.1443-1661.2010.00979.x.
    1. Horiuchi A., Nakayama Y., Kajiyama M., et al. Biliary stenting in the management of large or multiple common bile duct stones. Gastrointestinal Endoscopy. 2010;71(7):1200–1203.e2. doi: 10.1016/j.gie.2009.12.055.
    1. Hui C.-K., Lai K.-C., Ng M., et al. Retained common bile duct stones: a comparison between biliary stenting and complete clearance of stones by electrohydraulic lithotripsy. Alimentary Pharmacology and Therapeutics. 2003;17(2):289–296. doi: 10.1046/j.1365-2036.2003.01415.x.
    1. Donelli G., Guaglianone E., Di Rosa R., Fiocca F., Basoli A. Plastic biliary stent occlusion: factors involved and possible preventive approaches. Clinical Medicine and Research. 2007;5(1):53–60. doi: 10.3121/cmr.2007.683.
    1. Riemann J. F., Seuberth K., Demling L. Clinical application of a new mechanical lithotripter for smashing common bile duct stones. Endoscopy. 1982;14(6):226–230. doi: 10.1055/s-2007-1021626.
    1. Schneider M. U., Matek W., Bauer R., Domschke W. Mechanical lithotripsy of bile duct stones in 209 patients—effect of technical advances. Endoscopy. 1988;20(5):248–253. doi: 10.1055/s-2007-1018186.
    1. Hintze R. E., Adler A., Veltzke W. Outcome of mechanical lithotripsy of bile duct stones in an unselected series of 704 patients. Hepato-Gastroenterology. 1996;43(9):473–476.
    1. Garg P. K., Tandon R. K., Ahuja V., Makharia G. K., Batra Y. Predictors of unsuccessful mechanical lithotripsy and endoscopic clearance of large bile duct stones. Gastrointestinal Endoscopy. 2004;59(6):601–605. doi: 10.1016/S0016-5107(04)00295-0.
    1. Cipolletta L., Costamagna G., Bianco M. A., et al. Endoscopic mechanical lithotripsy of difficult common bile duct stones. British Journal of Surgery. 1997;84(10):1407–1409. doi: 10.1002/bjs.1800841019.
    1. Ersoz G., Tekesin O., Ozutemiz A. O., Gunsar F. Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract. Gastrointestinal Endoscopy. 2003;57(2):156–159. doi: 10.1067/mge.2003.52.
    1. Rosa B., Ribeiro R. M., Rebelo A., Correia A. P., Cotter J. Endoscopic papillary balloon dilation after sphincterotomy for difficult choledocholithiasis: a case-controlled study. World Journal of Gastrointestinal Endoscopy. 2013;5(5):211–218. doi: 10.4253/wjge.v5.i5.211.
    1. Stefanidis G., Viazis N., Pleskow D., et al. Large balloon dilation vs. mechanical lithotripsy for the management of large bile duct stones: A Prospective Randomized Study. American Journal of Gastroenterology. 2011;106(2):278–285. doi: 10.1038/ajg.2010.421.
    1. Minami A., Hirose S., Nomoto T., Hayakawa S. Small sphincterotomy combined with papillary dilation with large balloon permits retrieval of large stones without mechanical lithotripsy. World Journal of Gastroenterology. 2007;13(15):2179–2182. doi: 10.3748/wjg.v13.i15.2179.
    1. Bang S., Kim M. H., Park J. Y., Park S. W., Song S. Y., Chung J. B. Endoscopic papillary balloon dilation with large balloon after limited sphincterotomy for retrieval of choledocholithiasis. Yonsei Medical Journal. 2006;47(6):805–810. doi: 10.3349/ymj.2006.47.6.805.
    1. Rouquette O., Bommelaer G., Abergel A., Poincloux L. Large balloon dilation post endoscopic sphincterotomy in removal of difficult common bile duct stones: a literature review. World Journal of Gastroenterology. 2014;20(24):7760–7766. doi: 10.3748/wjg.v20.i24.7760.
    1. DiSario J., Chuttani R., Croffie J., et al. Biliary and pancreatic lithotripsy devices. Gastrointestinal Endoscopy. 2007;65(6):750–756. doi: 10.1016/j.gie.2006.10.002.
    1. Williams E. J., Green J., Beckingham I., et al. British Society of Gastroenterology. Guidelines on the management of common bile duct stones (CBDS) Gut. 2008;57(7):1004–1021. doi: 10.1136/gut.2007.121657.
    1. Sauer B. G., Cerefice M., Swartz D. C., et al. Safety and efficacy of laser lithotripsy for complicated biliary stones using direct choledochoscopy. Digestive Diseases and Sciences. 2013;58(1):253–256. doi: 10.1007/s10620-012-2359-1.
    1. Hochberger J., Bayer J., May A., et al. Laser lithotripsy of difficult bile duct stones: results in 60 patients using a rhodamine 6G dye laser with optical stone tissue detection system. Gut. 1998;43(6):823–829. doi: 10.1136/gut.43.6.823.
    1. Lee T. Y., Cheon Y. K., Choe W. H., Shim C. S. Direct cholangioscopy-based holmium laser lithotripsy of difficult bile duct stones by using an ultrathin upper endoscope without a separate biliary irrigating catheter. Photomedicine and Laser Surgery. 2012;30(1):31–36. doi: 10.1089/pho.2011.3094.
    1. Maydeo A., Kwek B. E. A., Bhandari S., Bapat M., Dhir V. Single-operator cholangioscopy-guided laser lithotripsy in patients with difficult biliary and pancreatic ductal stones (with videos) Gastrointestinal Endoscopy. 2011;74(6):1308–1314. doi: 10.1016/j.gie.2011.08.047.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi