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Lin YY, Wang YD, Yue P, Zhang XZ, Leung JW, Jiao PP, Yang M, Wang HP, Bai B, Liu Y, Zhang JD, Chen HB, Meng WB, Li X. Could saline irrigation clear all residual common bile duct stones after lithotripsy? A self-controlled prospective cohort study. World J Gastroenterol 2021; 27:358-370. [PMID: 33584068 PMCID: PMC7852583 DOI: 10.3748/wjg.v27.i4.358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/11/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A previous study showed that irrigation with 100 mL saline reduced residual common bile duct (CBD) stones, which potentially cause recurrent stones after endoscopic retrograde cholangiopancreatography.
AIM To determine whether saline irrigation can improve CBD clearance after lithotripsy.
METHODS This prospective self-controlled study enrolled patients receiving mechanical lithotripsy for large (> 1.2 cm) CBD stones. After occlusion cholangiography confirmed CBD stone clearance, peroral cholangioscopy (POC) was performed to determine clearance scores based on the number of residual stones. The amounts of residual stones spotted via POC were graded on a 5-point scale (score 1, worst; score 5, best). Scores were documented after only stone removal (control) and after irrigation with 50 mL and 100 mL saline, respectively. The stone composition was analyzed using infrared spectroscopy.
RESULTS Between October 2018 and January 2020, 47 patients had CBD clearance scores of 2.4 ± 1.1 without saline irrigation, 3.5 ± 0.7 with 50 mL irrigation, and 4.6 ± 0.6 with 100 mL irrigation (P < 0.001). Multivariate analysis showed that CBD diameter > 15 mm [odds ratio (OR) = 0.08, 95% confidence interval (CI): 0.01-0.49; P = 0.007] and periampullary diverticula (PAD) (OR = 6.51, 95%CI: 1.08-39.21; P = 0.041) were independent risk factors for residual stones. Bilirubin pigment stones constituted the main residual stones found in patients with PAD (P = 0.004).
CONCLUSION Irrigation with 100 mL of saline may not clear all residual CBD stones after lithotripsy, especially in patients with PAD and/or a dilated (> 15 mm) CBD. Pigment residual stones are soft and commonly found in patients with PAD. Additional saline irrigation may be required to remove retained stones.
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Affiliation(s)
- Yan-Yan Lin
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Clinical Medical College Cancer Center of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Yu-Dong Wang
- Department of General Surgery, The First Affiliated Hospital of Henan Polytechnic University, Jiaozuo 454001, Henan Province, China
| | - Ping Yue
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Clinical Medical College Cancer Center of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Xian-Zhuo Zhang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Joseph W Leung
- Department of Gastroenterology, Sacramento VA Medical Center, Mather, CA 95655-4200, United States
- Department of Gastroenterology and Hepatology, UC Davis Medical Center, Sacramento, CA 95817, United States
| | - Pan-Pan Jiao
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Man Yang
- Department of Gastroenterology, Songgang People’s Hospital, Shenzhen 518105, Guangdong Province, China
| | - Hai-Ping Wang
- Clinical Medical College Cancer Center of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Bing Bai
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Clinical Medical College Cancer Center of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Ying Liu
- School of Foreign Languages and Literatures, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Jin-Duo Zhang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Clinical Medical College Cancer Center of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Hong-Bo Chen
- School of Pharmaceutical Sciences, Sun Yat-sen University, Shenzhen 518105, Guangdong Province, China
| | - Wen-Bo Meng
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Clinical Medical College Cancer Center of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Xun Li
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Clinical Medical College Cancer Center of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
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Baron TH, Harewood GC. Endoscopic balloon dilation of the biliary sphincter compared to endoscopic biliary sphincterotomy for removal of common bile duct stones during ERCP: a metaanalysis of randomized, controlled trials. Am J Gastroenterol 2004; 99:1455-60. [PMID: 15307859 DOI: 10.1111/j.1572-0241.2004.30151.x] [Citation(s) in RCA: 249] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To compare the effect of endoscopic balloon dilation (EPBD) of the papilla with that of endoscopic biliary sphincterotomy (EST) in the treatment of patients with common bile duct stones. METHODS Searches of computerized bibliographic and scientific citations, and review of citations in relevant primary articles. Eight fully published prospective, randomized trials in English that compared EPBD with EST for the removal of common bile duct stones were subjected to metaanalysis. RESULTS EPBD compared with EST resulted in similar outcomes with regards to overall successful stone removal (94.3% vs 96.5%) and overall complications (10.5% vs 10.3%). Bleeding occurred less frequently with EPBD (0% vs 2.0%, p = 0.001). Post-ERCP pancreatitis occurred more commonly in the EPBD group (7.4% vs 4.3%, p = 0.05). No significant differences were seen in the rates of perforation or infection. Patients undergoing EPBD were more likely to require mechanical lithotripsy for stone extraction (20.9% vs 14.8%, p = 0.014). CONCLUSIONS On the basis of lower rates of bleeding, EPBD should be the preferred strategy over EST for endoscopic removal of common bile duct stones in patients with coagulopathy. Although EPBD is theoretically attractive for use in young patients for biliary sphincter preservation, the rate of pancreatitis is higher with EPBD and cannot be routinely recommended at this time.
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Affiliation(s)
- Todd H Baron
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Medical Center, Rochester, Minnesota, USA
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Moon JH, Cho YD, Ryu CB, Kim JO, Cho JY, Kim YS, Lee JS, Lee MS, Shim CS. The role of percutaneous transhepatic papillary balloon dilation in percutaneous choledochoscopic lithotomy. Gastrointest Endosc 2001; 54:232-6. [PMID: 11474400 DOI: 10.1067/mge.2001.116881] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND When choledochoscopic lithotomy with basket and electrohydraulic lithotripsy is used to remove intrahepatic duct stones, fragments or small stones usually remain in the bile duct that are too small to be captured with a basket. METHODS An attempt was made to remove stone fragments in 16 patients with intrahepatic duct stones by antegrade balloon dilation of the sphincter of Oddi with a conventional balloon catheter. After balloon dilation, remnant stones and sludge were pushed through the papilla with the choledochoscope. RESULTS Bile duct stones were completely removed in 12 of 16 patients (75%); stones were removed in 1 session. There was no clinical evidence of procedure-related pancreatitis or fatal complications. CONCLUSIONS Percutaneous transhepatic papillary balloon dilation of the sphincter of Oddi and clearance of remnant bile duct stones and stone fragments with the tip of choledochoscope is simple and effective in patients undergoing percutaneous transhepatic choledochoscopic lithotomy.
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Affiliation(s)
- J H Moon
- Institute for Digestive Research, Digestive Disease Center, Soon Chun Hyang University College of Medicine, Seoul, Korea
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