Treatment of common duct stones in patients with atypical papillae using small endoscopic sphincterotomy and endoscopic balloon dilatation / 中华肝胆外科杂志

Objective To evaluate the effect of small endoscopic sphincterotomy and endoscopic balloon dilatation in the treatment of common duct stones (CDS) in patients with atypical papillae (combined with diverticula; after surgical operation; combined with abnormal duodenal lumen with no definite cause).MethodsOne hundred and three patients with CDS and with atypical papillae treated from July 2007 to March 2010 were randomly divided into three groups.Thirty-four patients received endoscopic sphincterotomy (EST group),34 patients received endoscopic balloon dilatation (EBD group) and the remaining 35 patients received small endoscopic sphincterotomy and endoscopic balloon dilatation (EST+EBD group).The general state of the patients in the 3 groups showed no significant difference (P＞0.05).We tried to remove all CDS using baskets and/or balloons after the procedures on the papillae.In some patients the stones were crushed by using a basket mechanical lithotriptor (BML).In some patients with huge stones,we could only placed in a plastic stent because of the high risk of removing the stones in a single procedure.ResultsSuccessful endoscopic retrograde cholangiopancreatography (ERCP) was carried out in 96 patients.Patients in the EST+ EBD group had less complications,especially hemorrhage,when compared with the EST group (P＜0.05).Also,the EST+EBD group had a significantly higher success rate of complete stone removal (P＜0.05),decreased use of BML (P＜0.05) and decreased rate of acute pancreatitis when compared with the EBD group (P＜0.05).ConclusionsThe success rate of ERCP in managing patients with CDS with atypical papillae remained high.Small endoscopic sphincterotomy and endoscopic balloon dilatation had a higher success rate of removing stones at the first attempt and a decreased rate of complications.

Laparoscopic Cholecystectomy after an Endoscopic Sphincterotomy for Patients with Choledocholithiasis

BACKGROUND: Laparoscopic cholecystectomy (LC) has become the treatment of choice for patients with symptomatic gallbladder (GB) stones. About 10% of patients with symptomatic GB stones may have common duct (CD) stones at the same time. For patients with symptomatic GB stones and suspected CD stones, an endoscopic retrograde cholangiopancreaticography (ERCP) should be performed. The preferred approach to these patients is an ERCP, an endoscopic sphincterotomy (EST), and removal of the CD stones, followed by a LC. The aims of this study were to test the safety and to evaluate the efficacy of the endoscopic and laparoscopic procedure in patients with symptomatic GB stones associated with CD stones. MATERIAL AND METHODS: A retrospective review was conducted on 522 patients who had been treated surgically for GB stones with or without CD stones between Jul. 1994 and Jun 1997. Among them, an ERCP followed by a LC was performed in 57 (67.1%) of the 85 patients who had CD stones, a LC in 377, an open cholecystectomy in 60, and an open cholecystectomy and CD exploration in 28. RESULTS: There were significant differences in operation times, hospital stays, and postoperative complications between the group with an EST followed by a LC and the group with an open cholecystectomy and CD exploration, but no significant differences between the LC group and the group with an EST followed by a LC. CONCLUSIONS: An EST followed by a LC is a good and safe treatment mordality for patients with symptomatic GB stones associated with CD stones.

Long-Term Effect of Permanent Biliary Stenting for Endoscopically Unextractable Common Bile Duct Stone (s) / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic sphincterotomy (EST) has become a well-established therapeutic modality for common bile duct stone (s). EST and subsequent stone extraction, including mechanical lithotripsy, can clear bile duct in 85% to 95% of patients. Other therapeutic modalities which have been developed to enhance bile duct clearance including extracorporeal shock-wave lithotripsy, electrohydraulic or laser lithotripsy, and chemical dissolution are high cost, not yet widely available especially in community hospital, yet to be perfected, or still under clinical evaluation. The use of biliary stenting has been proposed as an alternative therapy for patients at high risk for surgery. We carried out this prospective, controlled study to evaluate the long-term effect of biliary stenting for endoscopically unextractable common bile duct stone (s). METHODS: Of the 233 patients with common bile duct stone (s) admitted at Gil Hospital from Jan. 1995 to Dec. 1996, the stent group were 14 patients with retained comrnon bile duct stone (s) in which 7Fr polyethylene biliary stent was placed with the proximal end above the stone and the distal end in the duodenum. The control group were 6 patients with common bile duct stone (s) not treated, because of patients refusal of surgical or endoscopic management. Follow-up was achieved by direct interview and telephone, and consisted of prospective analysis of all complications that occured during long-term follow-up period. Complication rates in the both groups were compared using chi-square test and cumulative complication-free rates were calculated by Kaplan-Meier analysis.