title: Endoscopic management of retained bile stones with an indwelling T-tube.
abstract: BACKGROUND
  Endoscopic sphincterotomy (ES) is widely used for the treatment of residual bile duct stones in patients who had common bile duct (CBD) exploration and T-tube insertion.
  
  
  METHODS
  In a 4-year period 45 patients were referred for endoscopic removal of residual bile duct stones. All patients had been operated 7-15 days earlier for choledocholithiasis and had a T-tube in the common bile duct (CBD).
  
  
  RESULTS
  Four patients were excluded. Three patients had a periampullary carcinoma and the fourth patient had no residual stone seen at cholangiography. All patients had a successful ES, conventional in 34, precut-knife in 3, and with the rendezvous technique in 4 patients. In 24 patients, all having stones distal to the T-tube, complete clearance of the CBD was achieved during one session and the T-tube was removed after 48 h. In the remaining 17 patients (15 having stones proximal to the T-tube), the T-tube had to be removed first and following stone extraction, a plastic stent was inserted in the CBD. Complete bile duct clearance and stent removal was achieved in a second session 3-4 weeks later. There were no serious complications or biliary related symptoms after the procedures and after a mean follow-up period of 18 months.
  
  
  CONCLUSIONS
  The endoscopic technique is safe and efficient for the treatment of residual stones after CBD exploration with a T-tube insertion, offering immediate cure compared to the percutaneous techniques. It is also an ideal method for the diagnosis of periampullary carcinomas.
authors.affiliation: Fourth Surgical Department, Hospital G. Papanikolaou, Aristotle University of Thessaloniki, Kiriakidou 16-20, Kalamaria, GR 55132, Thessaloniki, Greece. emmch@auth.gr
authors.forename: E
authors.initials: E
authors.lastname: Christoforidis
authors.forename: K
authors.initials: K
authors.lastname: Vasiliadis
authors.forename: I
authors.initials: I
authors.lastname: Goulimaris
authors.forename: D
authors.initials: D
authors.lastname: Botsios
authors.forename: H
authors.initials: H
authors.lastname: Tsorlini
authors.forename: D
authors.initials: D
authors.lastname: Betsis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D042883:Choledocholithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D016717:Sphincterotomy, Endoscopic; D017211:Treatment Failure