Endoscopic Therapy for Common Bile Duct Stones in Elderly Patients: Report of 421 Cases / 中国微创外科杂志

ABSTRACT

Objective To explore the efficacy of endoscopic therapy for common bile duct stones in the elderly. Methods From July 2003 to June 2006,421 elderly patients with common bile duct stones were treated in the Danyang People's Hospital(112 cases) and the Second Affiliated Hospital of Nanjing Medical University(309 cases).The clinical data of the patients were retrospectively analyzed Results ERCP was completed in all the 421 patients,of which 27 was converted to a pre-cut sphincterotomy because of difficulties in the deep cannulation of the bile duct.The diagnosis of common duct stones was confirmed during the operation in all the cases,and 46 of them were found complicated with cholecystolithiasis.Of the patients,266 patients had one stone,107 had two,and 48 had three or more.The calculi were removed using basket directly in 283 patients,balloon catheter in 122,lithotrity in 10,and plastic stent placement without calculus removal in 6.The stones were removed completed at the first operation in 392 cases,and the other 23 cases received a second operation after endoscopic nasobiliary drainage.Errhysis occurred in 20 patients during the pre-cut sphincterotomy,and was healed by locally sprinkling or injecting noradrenaline(110 000),or electric coagulation.Six patients had hemorrhage from the incision on the duodenal papilla 48 hours after the operation,and were cured by using submucous injection of noradrenaline(110 000,4 cases) or titanium clipper(2 cases).34 patients had a transient increase of serum amylase without abdominal pain;10 patients developed mild pancreatitis and then was cured by fasting,inhibiting pancreatic secretion and pancreatic enzyme activities,anti-inflammation therapy,and rehydration;4 patients developed cholangitis,and was cured by anti-inflammation therapy.All the patients were discharged without complications.342 of the patients were followed up for 6-12 months,4(1.2%) of them had recurrence of stones and was treated with endoscopy,3(0.9%) had cholangitis and received anti-inflammation therapy.In the 6 patients with plastic stent,the stones were dissolved in 2 of them in half a year.Conclusions Endoscopic therapy is safe and efficient for common bile duct stones in the elderly and is associated with a low rate of complications.