title: Non-invasive treatment for retained common bile duct stones in patients with T tube in situ: saline washout after intravenous ceruletide.
abstract: The combination of ceruletide-induced relaxation of the sphincter of Oddi plus flushing with saline has recently been proposed as a novel procedure for the treatment of residual common bile duct (CBD) stones. In this study we have administered intravenous ceruletide (2 ng kg-1 body weight min-1 for 1 h) plus intraductal saline (800-3000 ml, infused at a rate that kept biliary pressure below 30 cmH2O) to a group of 14 patients. The treatment induced the passage of residual stones in 11 subjects (79 per cent) with complete clearance in 7 (50 per cent). The majority of the cleared concretions (11/15) had a diameter less than 10 mm. No severe side-effects were recorded during the treatment. Four of the seven subjects who exhibited incomplete CBD clearance underwent a short cycle of mono-octanoin administration in order to reduce the size of residual radiolucent stones. This course of treatment was followed by another attempt with intravenous ceruletide and saline washout which gave a successful response in an additional three cases. These data indicate that the combination of ceruletide and flushing is a safe and inexpensive method for treatment of residual stones. The procedure is feasible for both radiolucent and radio-opaque stones and is mainly eligible for small concretions of diameter less than 10 mm. Larger (greater than 10 mm) radiolucent stones may be partially dissolved with mono-octanoin and then eliminated by the washout technique.
authors.affiliation: 3rd Surgical Clinic, University of Milan School of Medicine, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Tritapepe
authors.forename: C
authors.initials: C
authors.lastname: di Padova
authors.forename: F
authors.initials: F
authors.lastname: di Padova
mesh_terms: D000328:Adult; D000368:Aged; D002210:Caprylates; D002108:Ceruletide / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D042882:Gallstones / Q000628:therapy*; D005989:Glycerides / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D007440:Intubation; D008297:Male; D008875:Middle Aged; D012965:Sodium Chloride / Q000008:administration & dosage; D012997:Solvents / Q000627:therapeutic use; D009803:Sphincter of Oddi / Q000187:drug effects; D007507:Therapeutic Irrigation
chemical_list: D002210:Caprylates; D005989:Glycerides; D012997:Solvents; D012965:Sodium Chloride; D002108:Ceruletide; C025343:monooctanoin