Removal Of Common Duct Stones Research Articles

A study on the combined use of small endoscopic sphincterotomy plus balloon dilation to replace endoscopic sphincterotomy in the removal of common duct stones

Objective To evaluate whether small endoscopic sphincterotomy (EST) plus balloon dilation (EPBD) can replace endoscopic sphincterotomy (EST) alone for patients with common bile duct (CBD) stones.Methods From May 2008 to April 2011,462 patients with CBD stones were randomly divided into two groups.The success rate of complete stone removal after the first session,the rate of using mechanical lithotripsy (ML),the short-term complications,the procedure time and fluo roscopy time were compared between the two groups.Results Overall ductal clearance did not differ between the two groups (96.5％ vs 93.5％,P＞0.05).The complication rates at 24 hours were 6.9％ for the small EST plus EPBD group and 11.7％ for the EST group (P＞0.05).However,the rate of complete stone removal after the first session using small EST plus EPBD was significantly higher than EST alone (86.2％ vs 70.4％,P＜0.05).ML was required significantly more often in the EST group when compared with the small EST plus EPBD group (34.8％ vs 12.1％,P＜0.05).The total procedure time and total fluoroscopy time in the small EST plus EPBD group were significantly shorter than the EST group [(38.6±15.5) min vs (47.1±20.2) min,P＜0.05 and (17.3± 7.0) min vs (26.5±10.8) min,P＜0.05].Conclusions Compared with EST,small EST plus EPBD was safe and more efficacious for bile duct stones.In the future,small EST plus EPBD probably can replace EST to be the first treatment of choice for bile duct stones. Key words: Cholelithiasis; Sphincterotomy, endoscopic; Balloon dilation

Long-Term Follow-up Study of Gallbladder in Situ After Endoscopic Common Duct Stone Removal in Korean Patients

Background Although there has been much debate over the fate of the gallbladder (GB) after endoscopic common bile duct (CBD) stone removal, subsequent cholecystectomy is generally recommended in patients with GB stones to prevent further biliary complications. The aims of this study were to assess the natural course of the patients with GB in situ after endoscopic CBD stone removal and to evaluate the necessity of prophylactic cholecystectomy.

Common bile duct stones

Endoscopic sphincterotomy followed by retrieval balloons or baskets is 90% to 95% effective in removing common bile duct stones, and should be first-line therapy. Mechanical lithotripsy should be available for stones that are difficult to extract. Failure to clear the duct can be managed with temporary stenting, which may facilitate stone extraction at a later date; if not, either extracorporeal shock-wave lithotripsy, or intraductal laser lithotripsy is successful in the majority of cases. Balloon sphincter dilation should be considered in patients who are at high risk of bleeding from sphincterotomy due to coagulopathy. Surgical common bile-duct exploration can be performed as a last resort for removal of common duct stones.

Laparoscopic cholecystectomy during pregnancy is safe for both mother and fetus

The use of laparoscopic cholecystectomy in pregnant women has been slow to gain wide acceptance for two reasons: one is the potential for mechanical problems related to the pregnant uterus and the other is fear of fetal injury resulting from instrumentation or the pneumoperitoneum. To assess the effects of laparoscopic cholecystectomy on both the mother and the unborn fetus, we reviewed our surgical experience over a 5-year period analyzing indications for the procedure along with complications and outcome. During this 5-year period, 22 patients ranging in age from 17 to 31 years underwent laparoscopic cholecystectomy during pregnancy. Gestational ages ranged from 5 to 31 weeks with two patients being in the first trimester, 16 in the second, and four in the third. The primary indications for surgical intervention were persistent nausea, vomiting, pain, and inability to eat in 17 patients, acute cholecystitis in three and choledocholithiasis in two. In all patients a pneumoperitoneum was established by means of a closed technique starting in the right upper quadrant of the abdomen. Two of the 22 patients also underwent successful transcystic common bile duct exploration with removal of common duct stones. All 22 patients survived the surgical procedure without complications, and there were no fetal deaths or premature births related to the procedure. Based on the preceding results, it would appear that laparoscopic cholecystectomy during pregnancy is safe for both the mother and the unborn fetus. Indications for this procedure should include stringent criteria such as unrelenting biliary tract symptoms or the complications of cholelithiasis. If at all possible, when laparoscopic cholecystectomy is indicated, it should be performed either in the second trimester or early in the third.

Laparoscopic cholecystectomy during pregnancy is safe for both mother and fetus.

The use of laparoscopic cholecystectomy in pregnant women has been slow to gain wide acceptance for two reasons: one is the potential for mechanical problems related to the pregnant uterus and the other is fear of fetal injury resulting from instrumentation or the pneumoperitoneum. To assess the effects of laparoscopic cholecystectomy on both the mother and the unborn fetus, we reviewed our surgical experience over a 5-year period analyzing indications for the procedure along with complications and outcome. During this 5-year period, 22 patients ranging in age from 17 to 31 years underwent laparoscopic cholecystectomy during pregnancy. Gestational ages ranged from 5 to 31 weeks with two patients being in the first trimester, 16 in the second, and four in the third. The primary indications for surgical intervention were persistent nausea, vomiting, pain, and inability to eat in 17 patients, acute cholecystitis in three, and choledocholithiasis in two. In all patients a pneumoperitoneum was established by means of a closed technique starting in the right upper quadrant of the abdomen. Two of the 22 patients also underwent successful transcystic common bile duct exploration with removal of common duct stones. All 22 patients survived the surgical procedure without complications, and there were no fetal deaths or premature births related to the procedure. Based on the preceding results, it would appear that laparoscopic cholecystectomy during pregnancy is safe for both the mother and the unborn fetus. Indications for this procedure should include stringent criteria such as unrelenting biliary tract symptoms or the complications of cholelithiasis. If at all possible, when laparoscopic cholecystectomy is indicated, it should be performed either in the second trimester or early in the third.

Laparoscopic Removal of Common Duct Stones

Transcystic duct choledochoscopy is a safe and effective modality for clearing the common bile duct of stones encountered during laparoscopic cholecystectomy. The authors present early clinical experience with this new technique as developed at Cedars-Sinai Medical Center in Los Angeles.

Endoscopic removal of common duct stones: current indications and controversies

Endoscopic removal of common duct stones: current indications and controversies

Nursing Implications After Endoscopic Retrograde Cholangiopancreatography

The development of therapeutic endoscopic procedures over the past 20 years has been phenomenal. From the visualization of bile and pancreatic ducts years ago, technology has progressed to complex sphincterotomies, stenting and removal of common duct stones. Nurses working with these patients after these procedures need physical assessment skills and a knowledge base of both the therapeutic endoscopic procedures and the complications associated with the procedures.

Cholangiopancreatography, sphincterotomy, and common duct stone removal via Roux-en-Y limb enteroscopy

An enteroscopic method that uses a pediatric colonoscope provides an alternative approach to the diagnostic and management problems arising in the setting of a Roux-en-Y limb hepaticojejunostomy or biliary diversion. Three patients with Roux-en-Y limb reconstructions who experienced recurrent cholangitis, recurrent pancreatitis, or choledocholithiasis in whom the technique was used are presented. The technique, which uses colonoscopic principles, is discussed along with the combined use of percutaneous transhepatic assistance. Enteroscopy of a Roux-en-Y limb is technically feasible and expands the diagnostic and management approach to biliary and pancreatic disease involving this postoperative anatomic condition.

Percutaneous Removal of Common Duct Stones

Percutaneous Removal of Common Duct Stones

Percutaneous transhepatic removal of common duct stones: Report of ten patients

Ten patients aged 64–94 yr (mean 80 yr) underwent percutaneous transhepatic removal of common duct stones after endoscopic papillotomy and stone removal were judged to be contraindicated. The technique involved percutaneous placement of a modified Dormia basket in the common duct with its tip in the duodenum. The stones or fragments were then snared and carried into the duodenum. In 5 patients monooctanoin infusion was attempted after the basket procedure in order to remove sludge or fragments that resisted snaring or crushing. The stones were 0.5–2.5 cm in diameter. Symptoms disappeared in all 10 patients without further therapy. Complications included an abdominal wall abscess, an unexplained drop in hematocrit, a subcapsular hematoma, and one episode of pancreatitis. All complications resolved without further incident.

Endoscopic Diagnosis and Treatment of Biliary Tract Disease

Endoscopic sphincterotomy has proved to be an effective, safe, and cost-efficient method for removal of common duct stones and relieving benign and malignant obstructions of the papilla of Vater. The success rate has been high (90.1 per cent), the morbidity low (8.6 per cent), and the mortality zero.

T-Tube Cholangiography With Barium After Reaction to lodinated Contrast Medium

SEVERE reactions following the intravascular injection of iodinated contrast media include cardiovascular collapse, bronchospasm, urticaria, and abdominal and chest pain.^1,2Reactions during T-tube cholangiography are generally thought not to occur. Hess³states that he has never seen such a reaction during cholangiography. This report emphasizes that, although rare, such procedures can cause severe, allergic-type reactions. We have, in the patient to be described, averted the problem of reaction to iodinated contrast medium by substituting sterile barium sulfate and have employed this contrast agent in the nonoperative extraction of retained common duct stones. <h3>Report of a Case</h3> A 49-year-old man entered the hospital seven weeks after cholecystectomy and common duct exploration for the removal of common duct stones. The patient reported an allergic-type reaction during a previous intravenous urogram manifested by pruritus and urticaria. A subsequent T-tube cholangiogram, however, was performed without incident. There was no history of other