Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Cheonan, Republic of Korea.
Gastrointest Endosc. 2011 Jul;74(1):96-102. doi: 10.1016/j.gie.2011.03.005. Epub 2011 Apr 30.
Temporary biliary stenting is both technically easy and feasible, and choleretic agents such as ursodeoxycholic acid (UDCA) and a terpene preparation may promote a reduction in stone size. However, there are few comparative data on the effectiveness of choleretic agents available.
To investigate the efficacy of multiple double-pigtail stents with or without UDCA and terpene on difficult common bile duct (CBD) stones.
A prospective, multicenter study.
Four tertiary-care referral centers.
This study involved 51 patients.
In total, 51 elderly patients with comorbidities who had difficult CBD stones refractory to conventional methods were randomized to receive either multiple 7F double-pigtail stents (group A) or stents in combination with UDCA and terpene (group B) for a period of 6 months.
Stone size reduction, successful duct clearance, and complications.
Complete endoscopic duct clearance was achieved in 14 patients (73.7%) in group A and 19 patients (86.4%) in group B (P = .826). The mean size of CBD stones (transverse/longitudinal diameter, mean ± SD) was 19.12 ± 4.48 mm/20.47 ± 3.86 mm in group A and 21.30 ± 7.08 mm/22.58 ± 7.61 mm in group B. Stone size decreased significantly to 12.04 ± 3.26 mm/13.31 ± 5.12 mm and 13.67 ± 5.40 mm/14.04 ± 6.12 mm, respectively (P < .01). However, there was no statistical difference in stone size reduction between the two groups (P = .685, P = .289). No serious complications related to the stent or endoscopic procedures were observed, except for cholangitis (n = 1, group A) and distal stent migration (n = 2, group B).
Small number of patients in East Asia.
Temporary multiple double-pigtail biliary stenting was a safe and feasible method of treating difficult and large CBD stones in elderly patients and contributed to a reduction in stone size and successful duct clearance. However, the addition of choleretic agents did not result in a statistical difference in stone size or rate of successful duct clearance.
临时胆道支架置入术技术上简单可行，熊去氧胆酸（UDCA）和萜烯制剂等利胆剂可能有助于结石体积缩小。然而，关于利胆剂有效性的比较数据很少。
研究多发性双猪尾支架置入术联合或不联合 UDCA 和萜烯制剂治疗困难的胆总管（CBD）结石的疗效。
前瞻性、多中心研究。
四家三级转诊中心。
本研究共纳入 51 例患者。
共纳入 51 例患有难以治疗的 CBD 结石且对常规方法有抗性的老年合并症患者，随机分为两组：多发性 7F 双猪尾支架组（A 组）和支架联合 UDCA 和萜烯制剂组（B 组），治疗周期为 6 个月。
结石体积缩小、胆管通畅和并发症。
A 组 14 例（73.7%）和 B 组 19 例（86.4%）患者内镜下胆管完全清除（P =.826）。A 组 CBD 结石的平均大小（横径/长径，均值 ± 标准差）为 19.12 ± 4.48 mm/20.47 ± 3.86 mm，B 组为 21.30 ± 7.08 mm/22.58 ± 7.61 mm。结石体积显著缩小至 12.04 ± 3.26 mm/13.31 ± 5.12 mm 和 13.67 ± 5.40 mm/14.04 ± 6.12 mm（P <.01）。但两组结石体积缩小无统计学差异（P =.685，P =.289）。除胆管炎（A 组 1 例）和远端支架迁移（B 组 2 例）外，未观察到与支架或内镜操作相关的严重并发症。
东亚患者数量较少。
临时多发性双猪尾胆道支架置入术是治疗老年患者困难且大 CBD 结石的安全可行方法，有助于结石体积缩小和胆管通畅。然而，添加利胆剂并未在结石体积或胆管通畅率方面产生统计学差异。
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