title: Is the addition of choleretic agents in multiple double-pigtail biliary stents effective for difficult common bile duct stones in elderly patients? A prospective, multicenter study.
abstract: BACKGROUND
  Temporary biliary stenting is both technically easy and feasible, and choleretic agents such as ursodeoxycholic acid (UDCA) and a terpene preparation may promote a reduction in stone size. However, there are few comparative data on the effectiveness of choleretic agents available.
  
  
  OBJECTIVE
  To investigate the efficacy of multiple double-pigtail stents with or without UDCA and terpene on difficult common bile duct (CBD) stones.
  
  
  METHODS
  A prospective, multicenter study.
  
  
  METHODS
  Four tertiary-care referral centers.
  
  
  METHODS
  This study involved 51 patients.
  
  
  METHODS
  In total, 51 elderly patients with comorbidities who had difficult CBD stones refractory to conventional methods were randomized to receive either multiple 7F double-pigtail stents (group A) or stents in combination with UDCA and terpene (group B) for a period of 6 months.
  
  
  METHODS
  Stone size reduction, successful duct clearance, and complications.
  
  
  RESULTS
  Complete endoscopic duct clearance was achieved in 14 patients (73.7%) in group A and 19 patients (86.4%) in group B (P = .826). The mean size of CBD stones (transverse/longitudinal diameter, mean ± SD) was 19.12 ± 4.48 mm/20.47 ± 3.86 mm in group A and 21.30 ± 7.08 mm/22.58 ± 7.61 mm in group B. Stone size decreased significantly to 12.04 ± 3.26 mm/13.31 ± 5.12 mm and 13.67 ± 5.40 mm/14.04 ± 6.12 mm, respectively (P < .01). However, there was no statistical difference in stone size reduction between the two groups (P = .685, P = .289). No serious complications related to the stent or endoscopic procedures were observed, except for cholangitis (n = 1, group A) and distal stent migration (n = 2, group B).
  
  
  CONCLUSIONS
  Small number of patients in East Asia.
  
  
  CONCLUSIONS
  Temporary multiple double-pigtail biliary stenting was a safe and feasible method of treating difficult and large CBD stones in elderly patients and contributed to a reduction in stone size and successful duct clearance. However, the addition of choleretic agents did not result in a statistical difference in stone size or rate of successful duct clearance.
authors.affiliation: Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Cheonan, Republic of Korea. thlee9@lycos.co.kr
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.forename: Joung-Ho
authors.initials: JH
authors.lastname: Han
authors.forename: Hong Ja
authors.initials: HJ
authors.lastname: Kim
authors.forename: Seon Mee
authors.initials: SM
authors.lastname: Park
authors.forename: Sang-Heum
authors.initials: SH
authors.lastname: Park
authors.forename: Sun-Joo
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002756:Cholagogues and Choleretics / Q000008:administration & dosage*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000188:drug therapy* / Q000628:therapy; D004338:Drug Combinations; D005260:Female; D042882:Gallstones / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D039821:Monoterpenes / Q000008:administration & dosage; D011446:Prospective Studies; D019919:Prosthesis Implantation; D015607:Stents; D014580:Ursodeoxycholic Acid / Q000008:administration & dosage
chemical_list: D002756:Cholagogues and Choleretics; D004338:Drug Combinations; D039821:Monoterpenes; C018655:Rowachol; D014580:Ursodeoxycholic Acid