Retained common bile duct stones after endoscopic sphincterotomy: temporary and longterm treatment with biliary stenting.

Abstract

Background: Endoscopic extraction of biliary tract stones is safe and effective. When the procedure is not successful, the use of a biliary stent can be a solution.
Aim: To prospectively analyse the usefulness of a stenting in management of biliary obstruction due to choledocolithiasis.
Methods: All patients referred to our endoscopic unit from January 2005 to January 2008, for management of bile duct stone are studied. We included patients subjected to an endoscopic insertion of a biliary stent.
Results: Of 414 patients with choledocolithiasis, 51 failed to have their ducts cleared with the first endoscopic retrograde cholangiopancreatography (ERCP): 25 patients (6%) were referred to surgical stone removal. Twenty six consecutive patients had endoscopic insertion of a 10 Fr biliary stent: There were 12 men and 14 women ranging in age from 35 to 102 years (median age 68 years). The indications for stent placement in common bile duct stone were mainly the endoscopic portal hypertension, elderly patients or with a short life expectancy. Twenty four patients (88%) are symptom free after stenting. Six patients (23%) had duct clearance after a median of 3 sessions at a mean of 13 months (range 3-48 months). In 3 patients endoprosthesis was inserted as a permanent therapy of biliary obstruction. Cholangitis occurred in 5 patients, early in two cases and later at a mean of 18 months (range 6-24 months) in 3 patients and was managed endoscopically by stent replacement and fluid antibiotics.
Conclusions: These data favor temporary use of biliary endoprostheses in patients with endoscopically irretrievable bile duct stones until the definitive treatment is carried out. However, as a permanent therapy, late complications occur in many patients and the risk increases proportionally in time. Therefore, permanent biliary stenting should preferably be restricted to patients unfit for elective treatment at a later stage and with a short life expectancy.