EMS Removing Had Caused No Bile Duct Stenosis. Long Term Follow Up About Removal of Bile Duct Stones with An Expandable Metallic Stent

Abstract

Background: Recently expandable metallic stent (EMS) removing has been becoming little popular. But the long term results after removing EMS have not been published even now. We had published the new method using removable EMS for lithotripsy at 2003(1). This time we would like to show the long term result of EMS removing about our experience. EMS-Lithotripsy method was developed by us but this method could not become popular because we could not develop original stent for removing bile duct stones and the cost of EMS is relatively high. This presentation might give us the opportunity to develop the removable EMS and so we present long term results. Methods: Forty-six patients (18 women, 28 men; median age 68 +/- 10) with bile duct stones underwent ERCP. The median stone size was 11+/-4mm and the number was 3 +/- 3. A EMS was inserted over a guide wire into the major duodenal papilla. Papillary dilation was performed with a metallic stent. Stones were extracted with an 8-wire spiral basket after endoscopic mechanical lithotripsy through expanded EMS. The metallic stent was subsequently removed with a snare. On two cases choledochoscopy was performed to check the bile duct before and after the stent removing. 35 cases could be followed (mean 7.4 +/- 1.0 years). Result: Duct clearance was 44/46(96%). Lithotripsy was performed safely in 3 patients who had undergone partial gastrectomy with a Billroth II anastomosis. Two stent migration was occurred. These failed cases were caused by stent figure. After removing the stent reddening like meshes of stent was seen by choledochoscopy. 2 cases (6%) have occurred stone recurrence for over 5 years. One of them was B-II reconstruction case. We have not recognized the bile duct stenosis after metallic stent removing for over 5 years. Discussion: EMS removing was not so severe damage to the normal bile duct because bile duct stenosis case was none. The reduction of bile duct columnar epithelium by removing was suspected but sever injury to the fibromuscular layer was rare. So we suspect the removable metallic stent for the benign disease (bile duct stenose and formation of route to bile duct) should be developed. If original stent is established as a method of treatment and the shape of the stent is improved, then both the cost of the stent and the risk of migration may gradually decline. This method is not suitable for treatment of most stones. However, once the method is established as safe, it might play a greater role as a safe for diverticulum and bile duct stenosis case. A Minami et al. A new technique for removal of bile duct stones with an expandable metallic stent Gastrointest Endosc 2003;57: 945-948(1)