The Effect of Biliary Stenting with Combined UDCA and Rowachol Administration On Retained CBD Stones -Multicenter Study-

Abstract

Background & Aim: Endoscopic sphincterotomy and stone extraction is effective treatment of choice for patients with CBD stones. Endoscopic biliary stenting is one of the palliative treatment for the patients with impacted large CBD stones. Long-term treatment with biliary stenting can decrease the size of stone. Choleretic agents, UDCA and Rowachol, may enhance the dissolution of gallstones. We studied the effectiveness of a period of biliary stenting combined with UDCA and Rowachol administration as a medical treatment for difficult CBD stones. Patients & method: Between October 2005 and September 2007, a total of 21 patients (7 men; mean age; 71.5 years) with CBD stones failed on endoscopic removal including mechanical lithotripsy were enrolled. After trying endoscopic stone removal, we had placed 10F plastic stent above the top of stone, and medicated UDCA (600 mg) and Rowachol (300 mg) a day for 6 months (range: 3∼13). At 6 months of medication after initial ERCP or when stent was invisible during follow up, second ERCP was performed. The stone size and CBD diameter before and after stent insertion was compared and endoscopic stone removal was re-tried. Statistical analysis was done by Wilcoxon signed rank test. Result: Initial mean diameters (transverse × longitudinal) of CBD stones were 19.4 × 28.6 mm and decreased to 12.2 × 20.9 mm at 2nd ERCP after biliary stenting with medication (p < 0.05). Mean diameter of CBD measured at cystic duct insertion level was 22.6 mm and also decreased to 19.9 mm after biliary stenting with medication. Endoscopic stone removal was successful in 19 of 21 patients (90.4%) with mean 1.5 sessions of ERCP. Conclusion: The endoscopic biliary stenting with a period of combined UDCA and Rowachol administration for difficult CBD stones seems to be an effective and safe method as a medical treatment. For more significant results, a randomized, prospective study will be required.