PT  - JOURNAL ARTICLE
AU  - D G Maxton
AU  - D E Tweedle
AU  - D F Martin
TI  - Retained common bile duct stones after endoscopic sphincterotomy: temporary and longterm treatment with biliary stenting.
AID  - 10.1136/gut.36.3.446
DP  - 1995 Mar 01
TA  - Gut
PG  - 446--449
VI  - 36
IP  - 3
4099  - http://gut.bmj.com/content/36/3/446.short
4100  - http://gut.bmj.com/content/36/3/446.full
SO  - Gut1995 Mar 01; 36
AB  - Basket extraction after endoscopic sphincterotomy failed to clear the bile ducts immediately in 85 (30%) of 283 consecutive patients with common bile duct stones. Temporary biliary drainage was established by the insertion of a single 7 Fr double pigtail stent before further planned endoscopic attempts at stone removal. In 84 patients (21 male: 63 female, mean age 77 years) this measure relieved biliary obstruction, mean serum bilirubin falling from 101 to 18 umol/l by the time of the second endoscopic retrograde cholangiopancreatography. Six patients died from non-biliary causes with temporary stents in situ. Common bile duct stone extraction was achieved endoscopically in 50 of the remaining 79 patients after a mean of 4.3 months (range 1-12), 34 (68%) requiring only one further procedure. Three patients were referred for biliary surgery. Single stents were also effective for longterm biliary drainage in the remaining 26 elderly patients with unextractable stones. The main biliary complication of stenting was 13 episodes of cholangitis but all except one responded to medical treatment and early stent exchange. If common bile duct stones remain after endoscopic sphincterotomy, a single 7 Fr double pigtail stent is effective and safe for temporary biliary drainage before further endoscopic attempts at duct clearance and for longterm biliary drainage especially in the old and frail.