title: Failure of sequential biliary stenting for unsuccessful common bile duct stone removal.
abstract: OBJECTIVE
  To determine the factors associated with the failure of stone removal by a biliary stenting strategy.
  
  
  METHODS
  We retrospectively reviewed 645 patients with common bile duct (CBD) stones who underwent endoscopic retrograde cholangiography for stone removal in Siriraj GI Endoscopy center, Siriraj Hospital from June 2009 to June 2012. A total of 42 patients with unsuccessful initial removal of large CBD stones that underwent sequential biliary stenting were enrolled in the present study. The demographic data, laboratory results, stone characteristics, procedure details, and clinical outcomes were recorded and analyzed. In addition, the patients were classified into two groups based on outcome, successful or failed sequential biliary stenting, and the above factors were compared.
  
  
  RESULTS
  Among the initial 42 patients with unsuccessful initial removal of large CBD stones, there were 37 successful biliary stenting cases and five failed cases. Complete CBD clearance was achieved in 88.0% of cases. The average number of sessions needed before complete stone removal was achieved was 2.43 at an average of 25 wk after the first procedure. Complications during the follow-up period occurred in 19.1% of cases, comprising ascending cholangitis (14.3%) and pancreatitis (4.8%). The factors associated with failure of complete CBD stone clearance in the biliary stenting group were unchanged CBD stone size after the first biliary stenting attempt (10.2 wk) and a greater number of endoscopic retrograde cholangio-pancreatography sessions performed (4.2 sessions).
  
  
  CONCLUSIONS
  The sequential biliary stenting is an effective management strategy for the failure of initial large CBD stone removal.
authors.affiliation: Varayu Prachayakul, Siriraj Endoscopy Center, Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
authors.forename: Varayu
authors.initials: V
authors.lastname: Prachayakul
authors.forename: Pitulak
authors.initials: P
authors.lastname: Aswakul
keywords: Biliary stenting; Biliary stenting failure; Common bile duct stone; Endoscopic retrograde cholangiography; Large common bile duct stone