NEW YORK (Reuters Health) – Biliary stenting can be an effective therapy for large or multiple common bile duct (CBD) stones, new research shows.
With two months of stenting, stones either shrank or disappeared in 37 of 40 patients (93%), Dr. Akira Horiuchi of Showa Inan General Hospital in Komagane, Japan, and colleagues reported online April 19th in Gastrointestinal Endoscopy
Stones were cleared with endoscopic retrograde cholangiopancreatography (ERCP) procedure in all 37.
Three patients, each with a single large stone, had no change in diameter.
“Overall, these data suggest that for patients with (CBD) stones that are speculated to be difficult to extract, the elderly or high-risk patients, such as those taking anticoagulant and/or antiplatelet agents, stent placement for 2 months may be an effective alternative” – for example, to extracorporeal shock-wave lithotripsy, Dr. Horiuchi and his team said.
The researchers note, “Our experience has been that after stent placement, large stones often appeared smaller or disappeared.” As a result, they began using double-pigtail plastic stents as primary therapy for patients with large stones or more than three stones.
All 40 in the current study received stents, without attempts at stone extraction, at their initial ERCP. The stents remained in place for an average of 65 days (range, 50 to 82).
From the baseline ERCP to a second ERCP roughly two months later, the median stone index fell from 4.6 to 2. There were no stent-related complications.
“Use of a biliary stent as a sole treatment of CBD stones has been thought to be limited to patients with limited life expectancy or prohibitive surgical risk, or both,” the investigators write. “For the first time, the present study proposes that biliary stenting could be a primary method to reduce the size and number of difficult CBD stones, thus making extraction possible.”
Gastrointest Endosc 2010.