Brief Article
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World J Gastroenterol. Oct 21, 2013; 19(39): 6618-6624
Published online Oct 21, 2013. doi: 10.3748/wjg.v19.i39.6618
Anisodamine accelerates spontaneous passage of single symptomatic bile duct stones ≤ 10 mm
Jun Gao, Xue-Mei Ding, Shan Ke, Yi-Ming Zhou, Xiao-Jun Qian, Rui-Liang Ma, Chun-Min Ning, Zong-Hai Xin, Wen-Bing Sun
Jun Gao, Xue-Mei Ding, Shan Ke, Wen-Bing Sun, Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100043, China
Yi-Ming Zhou, Xiao-Jun Qian, Department of Radiology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100043, China
Rui-Liang Ma, Department of General Surgery, 254 Hospital of PLA, Tianjin 300142, China
Chun-Min Ning, Department of General Surgery, Chaoyang Central Hospital, Chaoyang 122000, Liaoning Province, China
Zong-Hai Xin, Department of General Surgery, Zhanhua People’s Hospital, Zhanhua 256800, Shandong Province, China
Author contributions: Gao J and Sun WB designed the study; Ke S, Ma RL, Ning CM and Xin ZH collected the data; Zhou YM and Qian XJ analyzed the radiological results; Ding XM and Ke S performed the literature search and analyzed the data; Gao J and Sun WB wrote the paper.
Correspondence to: Wen-Bing Sun, MD, Professor, Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, No. 5 Jingyuan Street, Beijing 100043, China. cyhswb@qq.com
Telephone: +86-10-51718372 Fax: +86-10-51718017
Received: July 11, 2013
Revised: August 12, 2013
Accepted: September 4, 2013
Published online: October 21, 2013
Processing time: 121 Days and 2.1 Hours
Abstract

AIM: To investigate the rate of spontaneous passage of single and symptomatic common bile duct (CBD) stones ≤ 10 mm in diameter in 4 wk with or without a 2-wk course of anisodamine.

METHODS: A multicenter, randomized, placebo-controlled trial was undertaken. A total of 197 patients who met the inclusion criteria were enrolled. Ninety-seven patients were assigned randomly to the control group and the other 100 to the anisodamine group. The anisodamine group received intravenous infusions of anisodamine (10 mg every 8 h) for 2 wk. The control group received the same volume of 0.9% isotonic saline for 2 wk. Patients underwent imaging studies and liver-function tests every week for 4 wk. The rate of spontaneous passage of CBD stones was analyzed.

RESULTS: The rate of spontaneous passage of CBD stones was significantly higher in the anisodamine group than that in the control group (47.0% vs 22.7%). Most (87.2%, 41/47) stone passages in the anisodamine group occurred in the first 2 wk, and passages in the control group occurred at a comparable rate each week. Factors significantly increasing the possibility of spontaneous passage by univariate logistic regression analyses were stone diameter (< 5 mm vs≥ 5 mm and ≤ 10 mm) and anisodamine therapy. Multivariate logistic regression analyses revealed that these two factors were significantly associated with spontaneous passage.

CONCLUSION: Two weeks of anisodamine administration can safely accelerate spontaneous passage of single and symptomatic CBD stones ≤ 10 mm in diameter, especially for stones < 5 mm.

Keywords: Common bile duct stones; Anisodamine; Spontaneous passage; Success rate; Randomized controlled trial

Core tip: Common bile duct (CBD) stones are known to pass spontaneously in many patients. This phenomenon has not been given sufficient emphasis in terms of optimizing the timing of management of CBD stones. We investigated the rate of spontaneous passage of single and symptomatic CBD stones ≤ 10 mm in diameter in 4 wk with or without a 2-wk course of anisodamine in a multicenter, randomized, placebo-controlled trial. Anisodamine administration for 2 wk can safely accelerate spontaneous passage of single and symptomatic CBD stones ≤ 10 mm in diameter, especially for stones < 5 mm.