Impact Of Indwelling Endoprostheses In Management Of Unextractable Common Bile Duct Stones: 2-Year, Tertiary-Center, Experience

Aims Placement of a biliary stent is often performed in patients with unextractable common bile duct (CBD) stones, although supported by moderate-quality evidence. We aimed to assess the role of biliary stenting in the management of unextractable CBD stones.

Methods We retrospectively analyzed a prospective database (1/2018-12/2019) including consecutive patients (n = 190, 53.7 % females, mean age: 75.4±11.2) who underwent ERCP for the management of CBD stones.

Results Successful stone clearance at the initial ERCP was 82.1 % (156/190), whereas 34/190 (17.9 %) patients with CBD stones that were unextractable by conventional endoscopic means underwent placement of a 7-10 Fr plastic stent. The mean CBD diameter (14.2±2.4 vs 13±2.2mm, p=0.01), largest stone diameter (13.1±1.9 vs 8.5±4.2mm, p=0.0001) and the rate with multiple (³3) stones (41.2 % vs 14.1 %, p=0.001) were significantly higher in patients with unextractable CBD stones. Thirty-three of these patients underwent a second ERCP with attempt to stone removal, following a range of 2-6 months. The diameter of the CBD (mean difference: -1.76mm, p=0.0001) and diameter of the largest stone (mean difference: -2.57mm, p=0.0001) were significantly reduced at the second ERCP, whereas in 6/14 patients with ³3 stones initially the number of stones was reduced to <3. At the second ERCP, 54.5 % (18/33) patients had complete stone clearance by conventional endoscopic techniques and 15.2 % (5/33) by cholangioscopy-guided electrohydraulic lithotripsy. Among the remaining 10 patients, 6 (18.2 %) underwent additional ERCP sessions (up to 4 sessions) and 4 (12.1 %) underwent alternative therapeutic approaches (percutaneous or surgical), and all of them achieved complete stone clearance.

Conclusions Temporary biliary stenting has a very positive effect on the size or fragmentation of unextractable CBD stones and serves as bridge to secondary intervention, thereby leading to high CBD clearance rates.

Citation Papastergiou V, Giannakopoulos A, Pantelakis E et al. eP327 IMPACT OF INDWELLING ENDOPROSTHESES IN MANAGEMENT OF UNEXTRACTABLE COMMON BILE DUCT STONES: 2-YEAR, TERTIARY-CENTER, EXPERIENCE. Endoscopy 2021; 53: S204.

Publication History

Article published online:
19 March 2021