Efficacy of ceruletide controlled saline infusion for retained ductal stones after cholecystectomy and exploration of the common bile duct.
The synthetic peptide ceruletide induces maximal relaxation of the sphincter of Oddi. In a preliminary communication, ceruletide controlled saline infusion of the common bile duct (CBD) was found to be effective in promoting the passage of retained ductal calculi after cholecystectomy and exploration of the common bile duct. This paper reports on the further experience with this simple treatment which was administered to 27 patients with retained ductal calculi in 16 different hospitals within the U.K. The success of the procedure was documented by repeat T-tube cholangiography. Passage of stones into the duodenum was documented in 13 patients (48%) with complete clearance in 9 (33%) following one saline infusion/ceruletide treatment. The radiological stone size ranged from 3 to 15 mm. Within this range, there was no correlation between a successful outcome and size of retained stones. The duration of the saline T-tube infusion during ceruletide treatment averaged 54.7/min (SD 14.3). There was no correlation between flow rate of saline through the T-tube and a successful outcome. A significant inverse correlation was observed between the CBD pressure during ceruletide controlled saline T-tube infusion and successful stone passage (chi 2 = 9.9, P less than 0.01). Ampullary impaction by a stone was encountered in one patient. These results are encouraging and indicate that pharmacological dilatation of the sphincter of Oddi together with saline infusion is effective in the management of retained stones after exploration of the common bile duct. This treatment, which does not require any special expertise, should be tried in the first instance before more invasive procedures are used.
Department of Surgery, Ninewells Hospital and Medical School, University of Dundee, U.K.
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Sadek
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Cuschieri
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002108:Ceruletide / Q000009:adverse effects / Q000627:therapeutic use*; D002763:Cholecystectomy; D005260:Female; D042882:Gallstones / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D012965:Sodium Chloride / Q000008:administration & dosage* / Q000627:therapeutic use; D012996:Solutions; D009803:Sphincter of Oddi / Q000187:drug effects
D012996:Solutions; D012965:Sodium Chloride; D002108:Ceruletide