title: Using cholecystokinin to facilitate endoscopic clearance of large common bile duct stones.
abstract: OBJECTIVE
  To evaluate the effect of cholecystokinin (CCK) during extracorporeal shockwave lithotripsy (ESWL) in the clearance of common bile duct (CBD) stones in endoscopic retrograde cholangiopancreatography (ERCP).
  
  
  METHODS
  Between January 2007 and September 2012, patients with large CBD stones who were treated with ESWL and ERCP were identified retrospectively. Patients were randomized in equal numbers to cholecystokinin (CCK) and no CCK groups. For each CCK case, a dose (3 ng/kg per min for 10 min) of sulfated octapeptide of CCK-8 was administered intravenously near the beginning of ESWL. ERCP was performed 4 h after a session of ESWL. The clearance rate of the CBD was assessed between the two groups.
  
  
  RESULTS
  A total of 148 consecutive cases (CCK group: 74, no CCK group: 74) were tallied. Overall there were 234 ESWLs and 228 ERCPs in the 148 cases. The use of CCK showed a significantly higher rate of successful stone removal in the first ESWL/ERCP procedure (71.6% vs 55.4%, P = 0.035), but resulted in similar outcomes in the second (42.8% vs 39.4%) and third (41.7% vs 40.0%) sessions, as well as total stone clearance (90.5% vs 83.8%). The use of mechanical lithotripsy was reduced in the CCK group (6.8% vs 17.6%, P = 0.023), and extremely large stone (≥ 30 mm) removal was higher in the CCK group (72.7% vs 41.7%, P = 0.038).
  
  
  CONCLUSIONS
  CCK during ESWL can aid with the clearance of CBD stones in the first ESWL/ERCP session. Mechanical lithotripsy usage was reduced and the extremely large stone (≥ 30 mm) clearance rate can be raised.
authors.affiliation: Tao Tao, Yan-Qing Li, Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Tao
authors.affiliation: Tao Tao, Yan-Qing Li, Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China.
authors.forename: Qi-Jie
authors.initials: QJ
authors.lastname: Zhang
authors.affiliation: Tao Tao, Yan-Qing Li, Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Tao Tao, Yan-Qing Li, Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Tao Tao, Yan-Qing Li, Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China.
authors.forename: Shu-Xia
authors.initials: SX
authors.lastname: Sun
authors.affiliation: Tao Tao, Yan-Qing Li, Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China.
authors.forename: Yan-Qing
authors.initials: YQ
authors.lastname: Li
mesh_terms: D000368:Aged; D002681:China; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D042882:Gallstones / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007262:Infusions, Intravenous; D008096:Lithotripsy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012844:Sincalide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: C090019:8-sulfocholecystokinin octapeptide; D012844:Sincalide
keywords: Cholecystokinin; Common bile duct stones; Endoscopic retrograde cholangiopancreatography; Extracorporeal shockwave lithotripsy
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