Effect of biliary stenting for unextractable choledocholithiasis

Abstract

Introduction Large choledocholithiasis is associated with higher rates of failed extraction with conventional endoscopic techniques. Alternative methods such as electrohydraulic lithotripsy and extracorporeal shock wave lithotripsy, laser lithotripsy, and dissolving solutions can remove 90% of difficult common bile stones. However, these methods are indicated only in special situations and require experience and additional equipment that may not be available in every center. Aim The aim of this study was to investigate the efficacy of biliary stenting in the treatment of endoscopically unextractable common bile duct (CBD) stones. Patients and methods A total of 46 patients with endoscopically unextractable CBD stones underwent placement of a plastic biliary stent. After 6 months, a second endoscopic retrograde cholangiopancreatography (ERCP) was performed and endoscopic stone removal was again attempted. Differences in stone size and CBD diameter before and after biliary stenting were compared. The complete stone removal rate after treatment was determined. Results The second ERCP procedure showed that the bile stone disappeared in 11 (23.91%) patients. Decreased stone size with complete stone removal was achieved in 29 (63.04%) patients. No significant changes were observed in the sizes of CBD stones and stone extraction eventually failed in six (13.04%) patients. Thus, in a total of 40 (87%) patients with unextractable stones, successful stone extraction was performed during the second ERCP. Conclusion Temporary biliary stenting has an established place in the management of large CBD stones and can facilitate stone extraction by a basket or a balloon catheter in the second ERCP.