title: Endoscopic management of recurrent primary bile duct stones.
abstract: BACKGROUND
  The management of recurrent choledocholithiasis today remains as challenging as in the pre-endoscopic era. Between 2 and 7% of affected patients have historically required surgical intervention for the treatment of recurrent or retained choledocholithiasis and of these, as many as 24% develop biliary complications. To avoid surgery, repeated endoscopic management of the problem has been suggested. In this study, we evaluate our policy of repeated endoscopic management of recurrent primary bile duct stones.
  
  
  METHODS
  This study examined a cohort of nine patients identified from a prospective database with recurrent choledocholithiasis. Demographic, clinical and investigative details were recorded and data were analysed. Complications were determined from a review of the patient's file.
  
  
  RESULTS
  There were nine patients and 66 procedures were carried out. Mean age at time of first endoscopy was 70.1 years (36-91 years). Three patients were of male sex (33.3%). The mean number of endoscopies carried out per patient was 7.3 (3-13). Failure to completely clear the duct occurred in 36.4% of all endoscopies. There were no periprocedural complications.
  
  
  CONCLUSIONS
  Repeated endoscopic stone extraction by endoscopic retrograde cholangiopancreatography when required is a safe policy. However, this technique will only provide temporary relief from primary duct stones and repeated endoscopic treatment, again safe, will be required.
authors.affiliation: Hepatobiliary/Upper Gastrointestinal Surgical Unit, Box Hill Hospital, Melbourne, Victoria, Australia. Geoffrey_Kohn@med.unc.edu
authors.forename: Geoffrey P
authors.initials: GP
authors.lastname: Kohn
authors.forename: A Sayed
authors.initials: AS
authors.lastname: Hassen
authors.forename: Simon W
authors.initials: SW
authors.lastname: Banting
authors.forename: Sean
authors.initials: S
authors.lastname: Mackay
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Cade
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042882:Gallstones / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence