Are there roles for intraductal US and saline solution irrigation in ensuring complete clearance of common bile duct stones?
BACKGROUND
Persistent small common bile duct (CBD) stones after endoscopic sphincterotomy (EST) and stone extraction may be a nidus for stone growth and could be detected by intraductal US (IDUS). CBD saline solution irrigation may flush out residual stones.


OBJECTIVE
Our purpose was to determine the frequency of residual CBD stones after EST and basket/balloon extraction by using IDUS and to assess the effectiveness of saline solution irrigation in clearing remnant CBD stones.


METHODS
Prospective study.


METHODS
General Hospital Singapore.


METHODS
Seventy patients (mean age 62 years, 51% male) were recruited.


METHODS
In the presence of CBD stones, EST and stone extraction were performed, followed by IDUS. If residual stones were detected, a catheter was inserted into the proximal CBD, saline solution irrigation performed, and IDUS repeated.


METHODS
(1) The frequency of residual stones detected by IDUS after EST and basket/balloon extraction and (2) the effect of saline solution irrigation in clearing residual CBD stones.


RESULTS
Cholangiogram showed CBD stones in 38 of 70 patients (median 1 [range 1-5], mean size 7.6 mm [range 3.0-12.0 mm]). IDUS showed CBD stones in 32 of 32 with normal cholangiogram (median 2 [range 1-8], mean size 2.6 mm [range 0.9-7.2 mm]). After EST and stone extraction, IDUS showed persistent stones in 28 of 70 (median: 2 [range 1-5], mean size 2.2 mm [range 1.1-4.6 mm]). The CBD was irrigated with a mean of 48 mL of saline solution. Repeat IDUS showed persistent CBD stones in 2 of 70, and these were flushed out by further saline solution irrigation.


CONCLUSIONS
Single-center study.


CONCLUSIONS
IDUS detected small residual CBD stones that persisted after EST and basket/balloon extraction. Saline solution irrigation appeared useful in clearing residual small stones.
Ang
Tiing Leong
TL
Division of Gastroenterology, Department of Medicine, Changi General Hospital, Singapore. tiing_leong_ang@cgh.com.sg
Teo
Eng Kiong
EK
Fock
Kwong Ming
KM
Lyn Tan
Jessica Yi
JY
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003135:Common Bile Duct / Q000000981:diagnostic imaging*; D019160:Endosonography; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012965:Sodium Chloride / Q000627:therapeutic use; D016717:Sphincterotomy, Endoscopic; D007507:Therapeutic Irrigation
D012965:Sodium Chloride