Non-operative treatment of retained bile duct calculi in patients with an indwelling T tube

Dissolution of common bile duct stones

Retained common duct stones can now be treated by a number of non-operative techniques, including dissolution by cholesterol solvents, simple irrigation, stone extraction via the T tube tract and by endoscopic sphincterotomy. This paper reviews the various solvents available for stone dissolution and its physicochemical basis. When a retained stone is found simple irrigation with saline will be successful in about 50 per cent of patients. If this fails, stone extraction via the T tube tract or by endoscopic sphincterotomy are now the methods of choice, with a 90--95 per cent chance of success. Stone dissolution by cholic acid is slow and is only successful in about 60 per cent of patients but can be of value when stone extraction is unavailable or unsuccessful.

What is involved in endoscopic sphincterotomy for gallstones?

This study reports our first year's experience of endoscopic sphincterotomy for common bile duct stones. Forty patients were considered for the procedure and it was attempted in 37. An effective endoscopic sphincterotomy was eventually achieved in 32 (86 cases per cent), 7 after a "pre-cut". Twenty-three patients passed stones spontaneously (72 per cent), 6 could not be reassessed and 3 still had stones present (9 per cent). Bed occupancy was 9.5 +/- 5.9 days. Complications occurred in 30 per cent, the most common being pancreatitis in 6 cases with 1 death. It is concluded that endoscopic sphincterotomy offers a valuable alternative to surgery in the management of common bile duct stones.