Endoscopic placement of biliary endoprostheses in patients with endoscopically unextractable common bile duct stones. A long-term follow up study of 26 patients.

Endoscopic sphincterotomy for removal of stones from the common bile duct, in particular in high-risk patients is an established procedure. However, the size of the stones and the appearance of the terminal bile duct prior to sphincterotomy have an influence on the outcome. In the period 1984-1987, thirty-four patients considered to be at high risk for surgery were treated endoscopically by insertion of a biliary endoprosthesis (15 cm long, 3.2 mm diameter) after unsuccessful attempts to remove common bile duct (CBD) stones following endoscopic sphincterotomy. These patients were admitted to the hospital with biliary colic, obstructive jaundice and/or cholangitis. Eight patients were lost to follow-up. The remaining patients comprised 20 females and 6 males, with a mean age of 81 years (range: 60-96). Five patients underwent surgical treatment for perforation (one patient, 11 months after insertion), persistent jaundice (one patient) or recurrent obstructive jaundice (endoprosthesis clogging in one, endoprosthesis dislodgement in two patients) 2 to 40 months after insertion. In one patient, recurrent obstructive jaundice was successfully treated by replacing the clogged endoprosthesis 4 months after the initial treatment. Ten patients died of unrelated causes (myocardial infarction, accident, etc.) 2 to 28 months after insertion. The remaining ten patients were still alive without symptoms after a median follow-up of 26 months. On the basis of these findings we therefore conclude that endoscopic insertion of a biliary endoprosthesis is a safe and effective treatment for huge CBD stones in high-risk patients in whom endoscopic sphincterotomy and attempts to remove the stones are not successful.