Published online Jul 16, 2013. doi: 10.4253/wjge.v5.i7.356
Revised: June 11, 2013
Accepted: June 18, 2013
Published online: July 16, 2013
The advantages of endoscopic retrograde cholangiopancreatography over open surgery have made it the predominant method of treating patients with choledocholithiasis. After sphincterotomy, however, 10%-15% of common bile duct stones cannot be removed with a basket or balloon. The methods for managing “irretrievable stones” include surgery, mechanical lithotripsy, intraductal or extracorporeal shock wave lithotripsy and biliary stenting. The case presented was a referred 82-year-old Caucasian woman with a 7-year-old plastic biliary endoprosthesis in situ. To the best of our knowledge the examined endoprosthesis is the oldest endoprosthesis in situ reported in the literature. Endoscopic biliary endoprosthesis placement remains a simple and safe procedure for patients with stones that are difficult to manage by conventional endoscopic methods and for patients who are unfit for surgery or who are high surgical risks. To date no consensus has been reached regarding how long a biliary prosthesis should remain in situ. Long-term biliary stenting may have a role in selected elderly patients if stones extraction has failed because the procedure may prevent stones impaction and cholangitis.
Core tip: Endoscopic extraction of biliary tract stones is safe and effective. When the procedure is not successful the placement of a plastic biliary endoprosthesis can be a solution. To date no consensus has been reached regarding how long the biliary prosthesis should remain in situ. This case report represents the oldest in situ plastic biliary endoprosthesis ever reported in the literature. Despite the fact that endoprostheses will inevitably occlude after 3 to 5 mo in situ, they may still prevent impaction of stones in the distal part of the common bile duct and ensure free flow of bile even if the endoprostheses are obstructed, calcified and have a bilious coat.