title: Effect of biliary stenting combined with ursodeoxycholic acid and terpene treatment on retained common bile duct stones in elderly patients: a multicenter study.
abstract: OBJECTIVE
  For frail, elderly patients with large impacted common bile duct (CBD) stones, long-term treatment with biliary stenting provides palliation. Biliary stenting with choleretic agents such as ursodeoxycholic acid (UDCA) and terpene preparations may promote CBD stone size reduction. We studied the effectiveness of biliary stenting combined with UDCA and a terpene preparation as a medical treatment for difficult-to-remove CBD stones in patients older than 65 years in this multicenter, prospective study.
  
  
  METHODS
  A total of 28 elderly patients with CBD stones refractory to conventional endoscopic removal, including mechanical lithotripsy, underwent endoscopic placement of a straight 10-F plastic biliary stent. Each patient was administered 600 mg of UDCA and 300 mg of a terpene preparation daily for a mean of 6 months. After 6 months of medication following the initial endoscopic retrograde cholangiopancreatography (ERCP), a second ERCP was performed and endoscopic stone removal was again attempted. Differences in stone size and CBD diameter before and after biliary stenting and medication were compared. The complete stone removal rate after treatment was obtained.
  
  
  RESULTS
  The mean size (transverse x longitudinal diameter) of the CBD stones was initially 21.6 x 29.5 mm, and it decreased significantly to 12.2 x 20.1 mm at the second ERCP (P<0.01). The mean CBD diameter measured initially at the cystic duct insertion level was 23.2 mm, and it decreased significantly to 19.5 mm at the second ERCP (P<0.01). After biliary stenting with medication, endoscopic stone removal was successful in 26 of 28 patients (92.8%), with a mean of 1.7 subsequent ERCP sessions.
  
  
  CONCLUSIONS
  Endoscopic biliary stenting with a period of combined UDCA and terpene preparation administration seems to be a safe and effective method for retained CBD stones in elderly patients. A prospective study with randomization and a control group is required to confirm these results.
authors: Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, South Korea.
authors: Jimin
authors: J
authors: Han
authors: Jong Ho
authors: JH
authors: Moon
authors: Hyun Cheol
authors: HC
authors: Koo
authors: Jee Heon
authors: JH
authors: Kang
authors: Joon Hyuck
authors: JH
authors: Choi
authors: Seok
authors: S
authors: Jeong
authors: Don Haeng
authors: DH
authors: Lee
authors: Moon Sung
authors: MS
authors: Lee
authors: Ho Gak
authors: HG
authors: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002756:Cholagogues and Choleretics / Q000627:therapeutic use*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D015607:Stents; D013729:Terpenes / Q000627:therapeutic use*; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use*
chemical_list: D002756:Cholagogues and Choleretics; D013729:Terpenes; D014580:Ursodeoxycholic Acid