Adding ursodeoxycholic acid to the endoscopic treatment and common bile duct stentingfor large and multiple biliary stones: Will it improve the outcomes?

Ahmad Hormati,Majid Moghaddam,Faezeh Alemi,Mohammad Reza Ghadir,Seyed Saeed Sarkeshikian,Sajjad Ahmadpour,Abolfazl Mohammadbeigi,Gholam Reza Sivandzadeh

doi:10.1186/s12876-020-01523-5

Abstract

BackgroundThe role of common bile duct (CBD) stenting in the establishment of bile stream in the elderly patients and the ones who are not good candidates for surgery due to not responding to treatments was well documented in previous studies. The current study aimed at investigating the effect of adding Ursodeoxycholic acid (UDCA) to CBD stenting alone in order to reduce the size of large and multiple CBD stones.MethodsClinical outcomes including success rates in CBD stones clearance, incidence of pancreatitis, perforation, bleeding, as well as, decrease in size of stones and liver enzymes after a two-month period were assessed in the UDCA + CBD stenting group.ResultsA total of 64 patients referring to Shahid Beheshti Hospital in Qom, Iran with multiple or large CBD stones (above three or larger than 15 mm) received standard endoscopic therapies and UDCA + CBD stenting (group B) and controls only received standard endoscopic therapies with only CBD stenting (group A). The mean reduction in the size of stones in group B was significantly higher than that of group A (3.22 ± 1.31 vs 4.09 ± 1.87 mm) (p = 0.034). There was no difference in the incidence rate of complications including pancreatitis, cholangitis, bleeding, and perforation between the two groups (P > 0.05).ConclusionAdding UDCA to CBD stenting, due to decrease in the stone size and subsequently facilitation of the stones outlet, can be considered as the first-line treatment for patients with large and multiple CBD stones. Also, in the cases with large or multi stones may be effective in reducing size and subsequently stone retrieval.Trial registry The study protocol was approved by the Ethics Committee of Qom University of Medical Sciences (ethical code: IR.MUQ.REC.1397.075); the study was also registered in the Iranian Registry of Clinical Trials (No. IRCT20161205031252N8). This study adheres to CONSORT guidelines.

Highlights

The role of common bile duct (CBD) stenting in the establishment of bile stream in the elderly patients and the ones who are not good candidates for surgery due to not responding to treatments was well documented in previous studies
Out of 64 patients enrolled in the current clinical trial, thirty-two cases in the control group underwent CBD stenting alone and the other 32 cases in the intervention group underwent CBD stenting + Ursodeoxycholic acid (UDCA)
Generally, it can be concluded that while common bile duct (CBD) stenting is an effective method for retaining the continuity of the bile flow in the elderly patients and the ones who are not good candidates for surgical treatment, adding UDCA to this treatment can improve the outcomes

Summary

Introduction

The role of common bile duct (CBD) stenting in the establishment of bile stream in the elderly patients and the ones who are not good candidates for surgery due to not responding to treatments was well documented in previous studies. Common bile duct (CBD) stone is found in approximately 7–12% of patients undergoing cholecystectomy for symptomatic gallstones, and is a common indication for endoscopic retrograde. The CBD stones vary in size, from 1–2 mm to above 3 cm in diameter. ERCP with endoscopic sphincterotomy and stone retrieval with basket and balloon is the therapeutic options commonly used to treat CBD stones. It is estimated that roughly 85–95% of all CBD stones can be effectively treated with these common methods [1]. CBD stones with a maximum diameter of 1.5 cm can be removed with the endoscopic sphincterotomy technique. Stones ≥ 15 mm should be broken up before extraction [2,3,4]

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Results

Discussion

Conclusion