Erkan PARLAK, Selçuk DİŞİBEYAZ, Mustafa KAPLAN, İhsan ATES, Mahmut YÜKSEL, Hakan YILDIZ, Ertuğrul KAYAÇETİN

Biliary stenting in difficult common bile duct stones: a single tertiary center experience

Background/aim: We aimed to examine the effect of plastic biliary stenting in the treatment of common bile duct (CBD) stones. Materials and methods: The data of 13,034 patients in our unit who had endoscopic retrograde cholangiopancreatography (ERCP) between 2008 and 2015 were scanned retrospectively. Results: A biliary stent was placed in 61 of 74 patients. While the plastic biliary stent was placed in patients, the mean stone size after the 1st ERCP was 20 mm and the bile duct size was 13 mm. At the time of the 2nd ERCP conducted approximately 73.9 days later, the mean stone size was found to be 15 mm and the bile duct size was 12 mm. With recurrent ERCPs, the CBD stone was successfully removed in 53 patients but could not be removed in 8 patients. Among the 53 successful cases, 29 removals were successful in the 2nd ERCP session, 16 were successful in the 3rd session, 2 were successful in the 4th session, 1 was successful in the 5th session, 4 were successful in the 6th session, and 1 was successful in the 7th session. Conclusion: For CBD stones that cannot be removed by standard methods, temporary plastic stenting is an alternative method.

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1. Joyce AM, Heiss FW. Endoscopic evaluation and therapies of biliary disorders. Surg Clin North Am 2008; 88: 1221-1240.
2. Kim HJ, Choi HS, Park JH, Park DI, Cho YK, Sohn CI, Jeon WK, Kim BI, Choi SH. Factors influencing the technical difficulty of endoscopic clearance of bile duct stones. Gastrointest Endosc 2007; 66: 1154-1160.
3. Chang WH, Chu CH, Wang TE, Chen MJ, Lin CC. Outcome of simple use of mechanical lithotripsy of difficult common bile duct stones. World J Gastroenterol 2005; 11: 593-596.
4. Binmoeller KF, Bruckner M, Thonke F, Soehendra N. Treatment of difficult bile duct stones using mechanical, electrohydraulic and extracorporeal shock wave lithotripsy. Endoscopy 1993; 25: 201-206.
5. Arya N, Nelles SE, Haber GB, Kim YI, Kortan PK. Electrohydraulic lithotripsy in 111 patients: a safe and effective therapy for difficult bile duct stones. American J Gastroenterol 2004; 99: 2330-2334.
6. Meyenberger C, Meierhofer U, Michel-Harder C, Knuchel J, Wirth HP, Buhler H, Munch R, Altorfer J. Long-term follow-up after treatment of common bile duct stones by extracorporeal shock-wave lithotripsy. Endoscopy 1996; 28: 411-417.
7. Gilchrist AM, Ross B, Thomas WE. Extracorporeal shockwave lithotripsy for common bile duct stones. Br J Surg 1997; 84: 29- 32.
8. Jakobs R, Maier M, Kohler B, Riemann JF. Peroral laser lithotripsy of difficult intrahepatic and extrahepatic bile duct stones: laser effectiveness using an automatic stone-tissue discrimination system. Am J Gastroenterol 1996; 91: 468-473.
9. Hochberger J, Tex S, Maiss J, Hahn EG. Management of difficult common bile duct stones. Gastrointest Endosc Clin N Am 2003; 13: 623-634.
10. Bergman JJ, Rauws EA, Tijssen JG, Tytgat GN, Huibregtse K. Biliary endoprostheses in elderly patients with endoscopically irretrievable common bile duct stones: report on 117 patients. Gastrointest Endosc 1995; 42: 195-201.
11. Horiuchi A, Nakayama Y, Kajiyama M, Kato N, Kamijima T, Graham DY, Tanaka N. Biliary stenting in the management of large or multiple common bile duct stones. Gastrointest Endosc 2010; 71: 1200-1203.e2.
12. Chan AC, Ng EK, Chung SC, Lai CW, Lau JY, Sung JJ, Leung JW, Li AK. Common bile duct stones become smaller after endoscopic biliary stenting. Endoscopy 1998; 30: 356-359.
13. Jain SK, Stein R, Bhuva M, Goldberg MJ. Pigtail stents: an alternative in the treatment of difficult bile duct stones. Gastrointest Endosc 2000; 52: 490-493.
14. Katsinelos P, Galanis I, Pilpilidis I, Paroutoglou G, Tsolkas P, Papaziogas B, Dimiropoulos S, Kamperis E, Katsiba D, Kalomenopoulou M et al. The effect of indwelling endoprosthesis on stone size or fragmentation after long-term treatment with biliary stenting for large stones. Surg Endosc 2003; 17: 1552-1555.
15. Cotton PB, Forbes A, Leung JW, Dineen L. Endoscopic stenting for long-term treatment of large bile duct stones: 2- to 5-year follow-up. Gastrointest Endosc 1987; 33: 411-412.
16. Lee DK, Jahng JH. Alternative methods in the endoscopic management of difficult common bile duct stones. Dig Endosc 2010; 22 (Suppl. 1): S79-84.
17. Maxton DG, Tweedle DE, Martin DF. Retained common bile duct stones after endoscopic sphincterotomy: temporary and longterm treatment with biliary stenting. Gut 1995; 36: 446- 449.
18. Panteris V, Vezakis A, Filippou G, Filippou D, Karamanolis D, Rizos S. Influence of juxtapapillary diverticula on the success or difficulty of cannulation and complication rate. Gastrointest Endosc 2008; 68: 903-910.
19. Lee SH, Park JK, Yoon WJ, Lee JK, Ryu JK, Kim YT, Yoon YB. How to predict the outcome of endoscopic mechanical lithotripsy in patients with difficult bile duct stones? Scand J Gastroenterol 2007; 42: 1006-1010.
20. Garg PK, Tandon RK, Ahuja V, Makharia GK, Batra Y. Predictors of unsuccessful mechanical lithotripsy and endoscopic clearance of large bile duct stones. Gastrointest Endosc 2004; 59: 601-605.
21. Shaw MJ, Mackie RD, Moore JP, Dorsher PJ, Freeman ML, Meier PB, Potter T, Hutton SW, Vennes JA. Results of a multicenter trial using a mechanical lithotripter for the treatment of large bile duct stones. Am J Gastroenterol 1993; 88: 730-733.
22. Lauri A, Horton RC, Davidson BR, Burroughs AK, Dooley JS. Endoscopic extraction of bile duct stones: management related to stone size. Gut 1993; 34: 1718-1721.
23. Pisello F, Geraci G, Li Volsi F, Modica G, Sciume C. Permanent stenting in unextractable common bile duct stones in high risk patients. A prospective randomized study comparing two different stents. Langenbecks Arch Surge 2008; 393: 857-863.
24. Riemann JF, Seuberth K, Demling L. Clinical application of a new mechanical lithotripter for smashing common bile duct stones. Endoscopy 1982; 14: 226-230.
25. Ang TL, Fock KM, Teo EK, Chua TS, Tan J. An audit of the outcome of long-term biliary stenting in the treatment of common bile duct stones in a general hospital. J Gastroenterol 2006; 41: 765-771.
26. Hui CK, Lai KC, Ng M, Wong WM, Yuen MF, Lam SK, Lai CL, Wong BC. Retained common bile duct stones: a comparison between biliary stenting and complete clearance of stones by electrohydraulic lithotripsy. Aliment Pharmacol Ther 2003; 17: 289-296.