title: Endoscopic sphincterotomy plus endoprostheses in the treatment of large or multiple common bile duct stones.
abstract: OBJECTIVE
  Little information is available on the outcomes of endoscopic sphincterotomy plus biliary stent placement without stone extraction as primary therapy at initial endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of large or multiple common bile duct (CBD) stones. The aim of the present study was to study the effect of biliary stents and sphincterotomy as primary therapy for patients with choledocholithiasis.
  
  
  METHODS
  Patients with large (≥20 mm) or multiple (≥3) CBD stones were retrospectively studied. The patients underwent endoscopic sphincterotomy and placement of plastic stents in the bile duct without stone extraction at the initial ERCP. Three or more months later, a second ERCP was carried out and stone removal was attempted. Differences in stone size and the largest CBD diameter before and after stenting were compared. Stone clearance and complications were also evaluated.
  
  
  RESULTS
  52 patients were enrolled. After a median of 124 days of biliary plastic stent placement the mean maximal stone diameter decreased from 16.6 mm to 10.0 mm (P < 0.01). The mean CBD diameter also decreased from 15.3 mm to 11.5 mm (P < 0.01). The total stone clearance at second ERCP was 94.2%, only 5.7% of which needed mechanical lithotripsy.
  
  
  RESULTS
  pancreatitis in one (1.9%) at initial ERCP, cholangitis in two (3.8%) after 52 days and 84 days of placement of stent. No complications were recorded at second ERCP.
  
  
  CONCLUSIONS
  Biliary plastic stents plus endoscopic sphincterotomy without stone extraction as primary therapy at initial ERCP is a safe and effective method in the management of large or multiple CBD stones.
authors.affiliation: Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, China.
authors.forename: Wan-dong
authors.initials: WD
authors.lastname: Hong
authors.forename: Qi-huai
authors.initials: QH
authors.lastname: Zhu
authors.forename: Qing-ke
authors.initials: QK
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D042883:Choledocholithiasis / Q000175:diagnosis / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D015607:Stents; D016896:Treatment Outcome