Published online Jun 27, 2013. doi: 10.4240/wjgs.v5.i6.210
Revised: May 22, 2013
Accepted: June 1, 2013
Published online: June 27, 2013
Processing time: 78 Days and 17.5 Hours
A retained bile duct stone after operation for cholelithiasis still occurs and causes symptoms such as biliary colic and obstructive jaundice. An endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy (EST), followed by stone extraction, are usually an effective treatment for this condition. However, these procedures are associated with severe complications including pancreatitis, bleeding, and duodenal perforation. Nitrates such as glyceryl trinitrate (GTN) and isosorbide dinitrate (ISDN) are known to relax the sphincter of Oddi. In 6 cases in which a retained stone was detected following cholecystectomy, topical nitrate drip infusion via cystic duct tube (C-tube) was carried out. Retained stones of 2-3 mm diameter and no dilated common bile duct in 3 patients were removed by drip infusion of 50 mg GTN or 10 mg ISDN, which was the regular dose of intravenous injection. Three other cases failed, and EST in 2 cases and endoscopic biliary balloon dilatation in 1 case were performed. One patient developed an adverse event of nausea. Severe complications were not observed. We consider the topical nitrate drip infusion via C-tube to be old but safe, easy, and inexpensive procedure for retained bile duct stone following cholecystectomy, inasmuch as removal rate was about 50% in our cases.
Core tip: In 6 cases in which a retained stone was detected following cholecystectomy, topical nitrate drip infusion via cystic duct tube (C-tube) was carried out. Retained stones of 2-3 mm diameter with no dilated common bile duct in 3 patients were removed by drip infusion of glyceryl trinitrate or isosorbide dinitrate. Three other cases failed, and endoscopic sphincterotomy in 2 cases and endoscopic biliary balloon dilatation in 1 case were performed. The topical nitrate drip infusion via C-tube is old but safe, easy, and inexpensive procedure for retained stone following cholecystectomy, inasmuch as removal rate was about 50% in our cases.