title: Analysis of plastic stents in the treatment of large common bile duct stones in 45 patients.
abstract: BACKGROUND
  Although endoscopic plastic biliary stenting is a clinical procedure routinely carried out in patients with common bile duct stones, the effects of stenting on the sizes or fragmentation of large common bile duct stones have not been formally established and the mechanism of this condition is controversial. We compared the stone sizes of common bile duct stones after biliary stenting in order to develop the mechanism.
  
  
  METHODS
  Endoscopic plastic biliary stenting was performed in 45 patients with large common bile duct stones or those difficult to extract with conventional endoscopic therapy, including mechanical lithotripsy. The stone diameter was ≥16mm in all patients. Bile duct drainage and endoscopic placement of 7-8.5 Fr plastic biliary stents were established in all patients. Differences of stone sizes and fragmentations after biliary stenting were compared. The complete stone clearance rate after treatment was obtained.
  
  
  RESULTS
  After biliary stenting for 3-6months, the bile stones disappeared or changed to sludge in 10 (10/45) patients, and fragmentation of the stones or decreased stone sizes were seen in 33 patients, whose stone median size was significantly decreased from 23.1mm to 15.4mm in 33 patients (P<0.05). The stones were removed successfully with basket, balloon, mechanical lithotripsy or a combination in 43 (43/45) patients. The remaining two patients (2/45) demonstrated no significant changes in stone sizes.
  
  
  CONCLUSIONS
  Plastic biliary stenting may fragment common bile duct stones and decrease stone sizes. This is an effective and feasible method to clear large or difficult common bile duct stones.
authors.affiliation: Department of Gastroenterology, Hangzhou First Hospital, Nanjing Medical University, Hangzhou, China. fanzhenmd@yahoo.com.cn
authors.forename: Zhen
authors.initials: Z
authors.lastname: Fan
authors.forename: Robert
authors.initials: R
authors.lastname: Hawes
authors.forename: Christopher
authors.initials: C
authors.lastname: Lawrence
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhang
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Zhang
authors.forename: Wen
authors.initials: W
authors.lastname: Lv
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome