Are there roles for intraductal US and saline solution irrigation in ensuring complete clearance of common bile duct stones?

Abstract

Persistent small common bile duct (CBD) stones after endoscopic sphincterotomy (EST) and stone extraction may be a nidus for stone growth and could be detected by intraductal US (IDUS). CBD saline solution irrigation may flush out residual stones. Our purpose was to determine the frequency of residual CBD stones after EST and basket/balloon extraction by using IDUS and to assess the effectiveness of saline solution irrigation in clearing remnant CBD stones. Prospective study. General Hospital Singapore. Seventy patients (mean age 62 years, 51% male) were recruited. In the presence of CBD stones, EST and stone extraction were performed, followed by IDUS. If residual stones were detected, a catheter was inserted into the proximal CBD, saline solution irrigation performed, and IDUS repeated. (1) The frequency of residual stones detected by IDUS after EST and basket/balloon extraction and (2) the effect of saline solution irrigation in clearing residual CBD stones. Cholangiogram showed CBD stones in 38 of 70 patients (median 1 [range 1-5], mean size 7.6 mm [range 3.0-12.0 mm]). IDUS showed CBD stones in 32 of 32 with normal cholangiogram (median 2 [range 1-8], mean size 2.6 mm [range 0.9-7.2 mm]). After EST and stone extraction, IDUS showed persistent stones in 28 of 70 (median: 2 [range 1-5], mean size 2.2 mm [range 1.1-4.6 mm]). The CBD was irrigated with a mean of 48 mL of saline solution. Repeat IDUS showed persistent CBD stones in 2 of 70, and these were flushed out by further saline solution irrigation. Single-center study. IDUS detected small residual CBD stones that persisted after EST and basket/balloon extraction. Saline solution irrigation appeared useful in clearing residual small stones.