Korean J Gastrointest Endosc.  2009 Sep;39(3):143-148.

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

• Lee TH
• Park SH
• Shim YS
• Lee SH
• Lee CK
• Chung IK
• Kim HS
• Kim SJ

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.

Keyword

ERCP; Common bile duct calculi; Stents; Ursodeoxycholic acid

MeSH Terms

Bile
Bile Ducts
Cholangiopancreatography, Endoscopic Retrograde
Common Bile Duct
Constriction, Pathologic
Diverticulum
Follow-Up Studies
Gallstones
Humans
Hypogonadism
Mitochondrial Diseases
Ophthalmoplegia
Risk Factors
Stents
Ursodeoxycholic Acid
Hypogonadism
Mitochondrial Diseases
Ophthalmoplegia
Ursodeoxycholic Acid