Combination Therapy Using Multi-biliary Endoprostheses and Oral Ursodeoxycholic Acid for Difficult, Large and Multiple Bile Duct Stones / 대한소화기내시경학회지

ABSTRACT

BACKGROUND/AIMS: Large common bile duct (CBD) stones accompanied by risk factors can be difficult to extract using conventional techniques. This study investigates the efficacy of combination therapy using multiple double pigtail stents and ursodeoxycholic acid (UDCA). METHODS: A total of 895 patients underwent the attempted removal of CBD stones. Multiple double pigtail stents (7 Fr or 10 Fr) were inserted into the CBD over a guidewire. The stents remained in place until endoscopic removal during a second attempt. All patients received oral UDCA (600 mg/day) during the follow-up. RESULTS: In 21 patients (2.34%), complete clearance was not achieved by the conventional method. Large, multiple stones, the presence of periampullary diverticulum, stricture of the distal CBD, and severe cardiopulmonary disease were observed as limiting factors for the successful removal of CBD stones. Complete endoscopic clearance was achieved in 12 patients (57.1%), and there was a statistically significant reduction in stone size (mean 4.60+/-2.45 mm, p=0.002). The mean duration of stenting and administration of medicine was 73.9 days. There was no immediate complication related to the procedure. CONCLUSIONS: Our results suggest that combination therapy using pigtail stents and UDCA may be an easy and effective method for removal of difficult CBD stones.