Management of difficult bile duct stones with temporary plastic stent and ursodeoxycholic acid treatment: 5 years of experience

Year 2022, , 305 - 310, 26.07.2022

Ali Duran , Alparslan Fedayi Çalta

https://doi.org/10.38053/acmj.1122657

Abstract

Aim: The aim of the study was to investigate the effect of temporary plastic stenting and ursodeoxycholic acid (UDCA) treatment on difficult choledochal stones that cannot be removed by basic ERCP techniques in patients who applied to our clinic with occlusion and underwent endoscopic retrograde cholangiopancreatography (ERCP).
Material and Method: Patients were scanned retrospectively using the hospital database. Patients who underwent ERCP due to malignancy, biliary tract injury and benign strictures were excluded from the study. 61 patients who were not successful with basic ERCP techniques such as endoscopic sphincterotomy (EST) and mechanical lithotripsy (ML) were included in the study. 750 mg/day UDCA was given to the patients for three months and plastic stent was applied. After the treatment, ERCP was tried again.
Results: Among the patients who underwent stent+UDCA, three (4.9%) patients had perioperative bleeding, one (1.6%) patient had peroperative perforation, four (6.6%) patients had postoperative pancreatitis, and one (1.6%) patient had mortality. The mean hospital stay was 1.96±2.1 days. Post-procedure total bilirubin and direct bilirubin values were observed to be lower than before the procedure (respectively, p<0.001 and p<0.001). The reduction in common bile duct diameter and stone size was found to be statistically significant in patients who underwent two procedures (respectively, p<0.001 and p<0.001). Although the reduction in stone size was statistically significant in patients who underwent three procedures, the decrease in the diameter of the common bile duct was not significant (p=0,090).
Conclusion: In our study, temporary plastic stenting and UDCA treatment were shown to be beneficial in common choledochal stones that could not be removed with basic ERCP techniques in the first ERCP session.

Keywords

Endoscopic retrograde cholangiopancreatography, choledocholithiasis, endoscopic sphincterotomy, ursodeoxycholic acid and bile duct stent

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