Endoscopic lithotomy of common bile duct stones with sublingual nitroglycerin and guidewire.
OBJECTIVE
In 21 patients, our objective was the endoscopic removal of common bile duct stones by sphincter dilation with the application of sublingual nitroglycerin.


METHODS
Nitroglycerin 0.3-0.6 mg was needed for proper dilation of the orifice and for successful cannulation of the Dormia basket into the bile duct. Cannulation of the Dormia basket was simplified by placing the guidewire in the common bile duct beforehand. Because of possible stone impaction, a mechanical lithotriptor was applied smoothly in two patients.


RESULTS
Complete stone removal was successful in 18 of the 21 (86%) patients. One patient who developed a mild form of acute pancreatitis recovered in a few days by conservative management with drip infusion of protease inhibitor. Blood pressure dropped transiently in a patient receiving nitroglycerin, but the general condition of the patient was stable.


CONCLUSIONS
This procedure was found to be safe, easy, and effective in extracting common bile duct stones.
Uchida
N
N
Third Department of Internal Medicine, Kagawa Medical University, Japan.
Ezaki
T
T
Hirabayashi
S
S
Minami
A
A
Fukuma
H
H
Matsuoka
H
H
Yachida
M
M
Kurokohchi
K
K
Morshed
S A
SA
Nishioka
M
M
Matsuoka
M
M
Nakatsu
T
T
D000208:Acute Disease; D000286:Administration, Sublingual; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000628:therapy*; D006801:Humans; D007262:Infusions, Intravenous; D008096:Lithotripsy / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage / Q000627:therapeutic use*; D010195:Pancreatitis / Q000188:drug therapy / Q000209:etiology; D011480:Protease Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D012449:Safety; D009803:Sphincter of Oddi / Q000187:drug effects; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013607:Tablets; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D011480:Protease Inhibitors; D013607:Tablets; D014665:Vasodilator Agents; D000681:Amylases; D005996:Nitroglycerin