title: Pigtail stents: an alternative in the treatment of difficult bile duct stones.
abstract: BACKGROUND
  When bile duct stones cannot be removed after sphincterotomy by balloon or basket extraction, stent placement can serve as a bridge to additional procedures. Biliary stents may also fragment large stones, allowing them to pass spontaneously or making them easier to extract at a later time.
  
  
  METHODS
  Twenty patients with difficult to extract bile duct stones were prospectively studied. The patients underwent ERCP and placement of a 7F double-pigtail stent in the bile duct for 6 months.
  
  
  RESULTS
  In seven patients (35%), repeat ERCP revealed no stones in the duct. Four patients (20%) had small stone fragments that were easily extracted with a balloon. Six patients (30%) continued to have large stones at repeat ERCP; two of these patients eventually underwent surgery, the duct was cleared in three with mechanical lithotripsy, and one had long-term stenting. Three patients (15%) did not undergo repeat ERCP and were therefore treated with long-term stent placement.
  
  
  CONCLUSIONS
  This study suggests that placement of a pigtail biliary stent is a safe and effective alternative in the management of bile duct stones that resist extraction if lithotripsy is not available. After 6 months of stent placement, stones may pass or become easier to remove in a significant proportion of patients.
authors.affiliation: Section of Gastroenterology, Department of Medicine, University of Chicago Hospital, Chicago, Illinois 60637, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Jain
authors.forename: R
authors.initials: R
authors.lastname: Stein
authors.forename: M
authors.initials: M
authors.lastname: Bhuva
authors.forename: M J
authors.initials: MJ
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging / Q000628:therapy; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents