Brief Article
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World J Gastrointest Endosc. Jun 16, 2013; 5(6): 288-292
Published online Jun 16, 2013. doi: 10.4253/wjge.v5.i6.288
Failure of sequential biliary stenting for unsuccessful common bile duct stone removal
Varayu Prachayakul, Pitulak Aswakul
Varayu Prachayakul, Siriraj Endoscopy Center, Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Pitulak Aswakul, Liver and Digestive Institute, Samitivej Sukhumvit Hospital, Bangkok 10120, Thailand
Author contributions: Prachayakul V developed the concept; Prachayakul V and Aswakul P performed data acquisition, and wrote and revised the paper for important intellectual content.
Correspondence to: Varayu Prachayakul, MD, Siriraj Endoscopy Center, Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Prannok Road, Bangkok 10700, Thailand. kaiyjr@gmail.com
Telephone: +66-662-4121088 Fax: +66-662-4199610
Received: January 8, 2013
Revised: April 24, 2013
Accepted: May 17, 2013
Published online: June 16, 2013
Abstract

AIM: 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).

CONCLUSION: The sequential biliary stenting is an effective management strategy for the failure of initial large CBD stone removal.

Keywords: Endoscopic retrograde cholangiography, Common bile duct stone, Biliary stenting, Large common bile duct stone, Biliary stenting failure

Core tip: This study was a retrospective review of 42 patients who underwent sequential biliary stenting following a failed removal of a large common bile duct stone by endoscopic retrograde cholangiopancreatography. Complete common bile duct (CBD) clearance was achieved in 88% of the patients at 25 wk after the first procedure, while 19% reported complications. The common complications were cholangitis and pancreatitis. The factors associated with the failure of this strategy were unchanged CBD stone size at the second biliary stenting attempt, and more endoscopic retrograde cholangio-pancreatography sessions performed.