Katsinelos P, Galanis I, Pilpilidis I, Paroutoglou G, Tsolkas P, Papaziogas B, Dimiropoulos S, Kamperis E, Katsiba D, Kalomenopoulou M, Papagiannis A
Department of Endoscopy and Motility Unit, Central Hospital, Ethnikis Aminis 41, TK 546 35 Thessaloniki, Greece.
Surg Endosc. 2003 Oct;17(10):1552-5. doi: 10.1007/s00464-002-9240-9. Epub 2003 Aug 15.
Endoscopic biliary stenting is often used for large or difficult common bile duct (CBD) stones, but the effect of indwelling endoprosthesis on size or fragmentation of stones after long-term treatment with biliary stenting has not been formally established. We compared the stone size or fragmentation of common bile duct stones after a long period of biliary stenting.
Endoscopic biliary endoprosthesis was performed for 49 high-risk patients with CBD stones too large or difficult to be extracted by conventional endoscopic means. Bile duct drainage was established in all the patients without complications. Of the patients, 24 died with endoprosthesis in situ all from causes unrelated to biliar disease; 22 underwent a second and three patients a third attempt at stone extraction. The largest stone diameter was >12 mm in all patients.
In 11 of 25 patients (44%) the endoprosthesis allowed resolution of the problem of unextractable common bile duct stones. Four patients showed no existence of stent, and ERCP complete stone clearance from the CBD on programmized appointment after endoprosthesis insertion. Reduced size or fragmentation of stones was obtained in seven patients, and the stones could be removed endoscopically. The remaining 14 patients demonstrated no significant change in the size or fragmentation of their stones, and endoprostheses were replaced.
These results suggest that endoscopic endoprosthesis for large or difficult CBD stones is an effective method to clear the duct in selected cases, as well as an important definitive treatment in high-risk patients.
内镜下胆管支架置入术常用于治疗较大或难以处理的胆总管结石，但长期胆管支架置入治疗后，留置的内支架对结石大小或碎裂的影响尚未得到正式证实。我们比较了长期胆管支架置入术后胆总管结石的大小和碎裂情况。
对49例因胆总管结石过大或常规内镜方法难以取出而具有高风险的患者进行了内镜下胆管内支架置入术。所有患者均成功建立胆管引流且无并发症。其中，24例患者内支架原位留置时死亡，死因均与胆道疾病无关；22例患者进行了第二次取石尝试，3例患者进行了第三次取石尝试。所有患者最大结石直径均>12 mm。
25例患者中有11例（44%）通过内支架解决了无法取出的胆总管结石问题。4例患者内支架已不存在，在内支架置入后按计划预约的ERCP检查显示胆总管结石已完全清除。7例患者结石尺寸减小或碎裂，结石可通过内镜取出。其余14例患者结石大小和碎裂情况无明显变化，更换了内支架。
这些结果表明，对于较大或难以处理的胆总管结石，内镜下内支架置入术在某些病例中是清除胆管的有效方法，也是高风险患者的重要确定性治疗方法。
