Short-Term Biliary Stent Placement Contributing Common Bile Duct Stone Disappearance with Preservation of Duodenal Papilla Function.

Tatsuki Ueda,Masataka Kikuyama,Yuzo Kodama,Takafumi Kurokami

doi:10.1155/2016/6153893

Abstract

Aims. To investigate the effect of biliary stent placement without endoscopic sphincterotomy (EST) on common bile duct stones (CBDS) disappearance and the contribution of preserving the duodenal papilla function to reduce recurrence of CBDS. Methods. Sixty-six patients admitted for acute obstructive cholangitis due to CBDS who underwent biliary stent placement without EST for 2 years from March 2011 were evaluated retrospectively. The second endoscopic retrograde cholangiopancreatography (ERCP) was performed for treatment of CBDS 3 to 4 months after the first ERCP. We estimated the rate of stone disappearance at the time of second ERCP. Results. CBDS disappearance was observed in 32 (48.5%) of 66 patients. The diameter of the bile ducts and the diameter of CBDS in patients with CBDS disappearance were significantly smaller than in those with CBDS requiring extraction (p = 0.007 and p < 0.001, resp.). Stone disappearance was evident when the diameter of bile ducts and that of CBDS were <10 and 7 mm, respectively (p = 0.002). Conclusions. Short-term stent placement without EST eliminates CBDS while preserving duodenal papilla function and may be suitable for treating CBDS in patients with nondilated bile ducts and small CBDS.

Highlights

To treat common bile duct stones (CBDS), endoscopic sphincterotomy (EST) is an established procedure and is widely performed
Late complications including liver abscess, cholangitis, CBDS recurrence, and bile duct cancer have recently been reported with this technique [1, 2], the occurrence of which is probably due to reflux into the bile duct of duodenal juice, which contains both pancreatic juice and bacteria
Endoscopic papillary balloon dilation is an alternative method for treatment of CBDS [3], and it has the advantage of preserving duodenal papillary function [4]

Summary

Introduction

To treat common bile duct stones (CBDS), endoscopic sphincterotomy (EST) is an established procedure and is widely performed. Compared with EST, a higher rate of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) has been reported [4], and this remains a potential hazard when using this method for treatment of CBDS. Biliary stent placement is widely performed for acute obstructive cholangitis (AOC) due to CBDS. This procedure is easy to perform, effective, and accepted as an emergent treatment [5, 6]. In patients with difficult stones, biliary stent placement to drain obstructed bile juice due to CBDS can be selected [7,8,9,10]. Some reports have described a decrease in size and diameter, as well as disappearance of stones in patients with biliary stent placement after EST [7, 8]

Methods

Results

Conclusion