Outcome of the Endoscopic Biliary Stenting for Irretrievable Common Bile Duct Stones in an Academic Hospital – A Prospective Study

Abstract

Background: Choledocholithiasis is characterized by the existence of a stone in the common bile duct. Based on findings published in the Medical Clinics of North America, around 10-15% of individuals with gallstones experience the development of choledocholithiasis. Presently, the established approach for addressing common bile duct stones involves the implementation of endoscopic papillotomy and stone extraction. The combined utilization of Dormia basket, balloon catheter, and lithotripsy achieves a success rate of approximately 90%. In cases where traditional endoscopic removal methods prove ineffective, biliary stenting plays a crucial role in the conservative management of CBD stones. Objectives: The main goal of the study was to evaluate the outcome of biliary stenting in irretrievable common bile duct stones. Materials and Methods: This observational study took place at the Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, from January 2018 to December 2018. The study included consecutive patients who were 18 years or older and diagnosed with common bile duct stones. These patients underwent endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction. The study specifically focused on patients who received biliary stenting for irretrievable common bile duct stones, and they were enrolled as participants in the study. Results: Out of the 83 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction, 29 patients (35%) were deemed as having irretrievable stones, necessitating the implementation of stenting. Among these irretrievable stone cases, the average age was 46.69, and there was a predominance of females with 17 patients (58.6%). Of the 29 cases, 22 patients completed the follow-up. During the follow-up ERCP, a significant reduction was observed in both the average number of stones (3.14 vs. 1.9; P=0.002) and their size (16.32 vs. 12.4; P=0.005). Successful stone extraction was achieved in 14 patients (63.64%) during the second ERCP. In one patient (4.55%), spontaneous clearance of the stone occurred, while in 7 patients (31.81%), stone extraction was not possible during the second ERCP. The reduction in mean stone size was the only significant factor affecting the success of the second ERCP. However, there was no correlation found between the duration of stenting and the reduction in stone size (r=-0.193, p=0.401). Conclusion: Our study shows that repeat ERCP can successfully extract stones regardless of stenting duration. Unlike Western data, we emphasize the effectiveness of endoscopic biliary stenting in a context with limited access to advanced techniques, where initial stone extraction rates are lower. This approach is particularly beneficial for patients with stone sizes over 15 mm, avoiding the need for complex surgical procedures.