Endoscopic management of retained bile stones with an indwelling T-tube

• Published in: Surgical endoscopy Vol. 18; no. 11; pp. 1582 - 1586
• Main Authors: CHRISTOFORIDIS, E, VASILIADIS, K, GOULIMARIS, I, BOTSIOS, D, TSORLINI, H, BETSIS, D
• Format: Journal Article
• Language: English
• Published: New York, NY Springer 01.11.2004; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Bile ducts; Biological and medical sciences; Cholecystectomy; Choledocholithiasis - surgery; Endoscopy; Female; General aspects; Humans; Male; Medical sciences; Middle Aged; Patients; Prostheses and Implants; Sphincterotomy, Endoscopic; Treatment Failure; Medicine; Clinical management; Treatment; Tube; CBD exploration; periampullary carcinoma; T-tube; Endoscopy; endoscopic sphincterotomy; Bile
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-003-9272-9

Endoscopic sphincterotomy (ES) is widely used for the treatment of residual bile duct stones in patients who had common bile duct (CBD) exploration and T-tube insertion. In a 4-year period 45 patients were referred for endoscopic removal of residual bile duct stones. All patients had been operated 7-15 days earlier for choledocholithiasis and had a T-tube in the common bile duct (CBD). Four patients were excluded. Three patients had a periampullary carcinoma and the fourth patient had no residual stone seen at cholangiography. All patients had a successful ES, conventional in 34, precut-knife in 3, and with the rendezvous technique in 4 patients. In 24 patients, all having stones distal to the T-tube, complete clearance of the CBD was achieved during one session and the T-tube was removed after 48 h. In the remaining 17 patients (15 having stones proximal to the T-tube), the T-tube had to be removed first and following stone extraction, a plastic stent was inserted in the CBD. Complete bile duct clearance and stent removal was achieved in a second session 3-4 weeks later. There were no serious complications or biliary related symptoms after the procedures and after a mean follow-up period of 18 months. The endoscopic technique is safe and efficient for the treatment of residual stones after CBD exploration with a T-tube insertion, offering immediate cure compared to the percutaneous techniques. It is also an ideal method for the diagnosis of periampullary carcinomas.