Retained common bile duct stones: a comparison between biliary stenting and complete clearance of stones by electrohydraulic lithotripsy.
BACKGROUND
There is some uncertainty as to whether high-risk patients with difficult common bile duct stones should be subjected to a further endoscopic procedure for the complete removal of stones by electrohydraulic lithotripsy or whether permanent biliary stenting should be performed.


OBJECTIVE
To compare the outcome of permanent biliary stenting with electrohydraulic lithotripsy in this group of patients.


METHODS
In a prospective study, 36 patients with difficult common bile duct stones were investigated: 19 underwent double pigtail insertion (stent group), whereas 17 underwent complete clearance of stones (electrohydraulic lithotripsy).


RESULTS
In the electrohydraulic lithotripsy group, successful stone clearance was achieved in 76.5%, whereas, in the stent group, the success of stenting was 94.7%. A significant difference was detected in the actuarial incidence of recurrent acute cholangitis when the electrohydraulic lithotripsy group was compared with the stent group [one patient (7.7%) vs. 12 patients (63.2%), respectively; P = 0.002, log rank test]. A significant difference was detected in the actuarial frequency of mortality between the electrohydraulic lithotripsy and stent groups [seven patients (41.2%) vs. 14 patients (73.7%), respectively; P = 0.01, log rank test].


CONCLUSIONS
The removal of difficult common bile duct stones by electrohydraulic lithotripsy and further endoscopic retrograde cholangiopancreatography has a high success rate and a low complication rate even in the elderly.
Hui
C-K
CK
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Lai
K-C
KC
Ng
M
M
Wong
W-M
WM
Yuen
M-F
MF
Lam
S-K
SK
Lai
C-L
CL
Wong
B C Y
BC
D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D002761:Cholangitis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000628:therapy*; D006801:Humans; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D012008:Recurrence; D015607:Stents / Q000009:adverse effects