Abstract
Background
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.
Methods
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).
Results
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.
Conclusion
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.
Similar content being viewed by others
References
B Allen H Shapiro LW Way (1981) ArticleTitleManagement of recurrent and residual common duct stones Am J Surg 142 41–47 Occurrence Handle7258513
BCD Becker F Eigenmann U Siheuver F Halter (1999) ArticleTitleComparison of percutaneous and endoscopic retrograde removal of postoperatively retained bile duct stones Cardiovasc Intervent Radiol 16 144–149
HJ Burhenne (1980) ArticleTitlePercutaneous extraction of retained biliary tract stones: 661 patients Am J Roentgenol 134 888–898
DH Burkett LF Williams (1981) ArticleTitlePrevention and management of retained bile duct stones Surg Clin North Am 61 939 Occurrence Handle7025302
TK Choi J Wong GB Ong (1982) ArticleTitleThe surgical management of primary intrahepatic stones Br J Surg 69 86–90 Occurrence Handle7059773
E Christoforidis I Goulimaris I Kanellos K Tsalis Demetriades Ch D Betsis (2002) ArticleTitlePost-ERCP pancreatitis and hyperamylasaemia: patients' related and operative risk factors Endoscopy 34 286–292 Occurrence Handle10.1055/s-2002-23630 Occurrence Handle11932783
InstitutionalAuthorNameCotton PB: Retained bile duct stones (1990) ArticleTitleT-tube in place, percutaneous or endoscopic management? Am J Gastroenterol 85 1075–1078
MD Danilewitz (1989) ArticleTitleEarly postoperative endoscopic sphincterotomy for retained common bile duct stones Gastrointest Endosc 35 328–329
DV Feliciano KL Mattox GL Jordan (1980) ArticleTitleThe value of choledochoscopy in explorations of the common bile duct Ann Surg 191 649–653 Occurrence Handle7369825
ME Gamal A Szabo E Szüle A Vörös P Metzger G Kovacs J Rozsahegyi A Olah I Rozca J Kiss (2001) ArticleTitlePercutaneous video choledochoscopic treatment of retained biliary stones via dilated T-tube tract Surg Endosc 15 473–476 Occurrence Handle10.1007/s004640000274 Occurrence Handle11353964
F Glenn (1974) ArticleTitleRetained calculi within the biliary duct system Ann Surg 179 528–539 Occurrence Handle4823834
K Gürel B Onal (2002) ArticleTitlePercutaneous management of bile duct stones Eur J Radiol 43 237–245 Occurrence Handle10.1016/S0720-048X(02)00159-6 Occurrence Handle12204406
JK Han BI Choi JH Park MC Ham (1992) ArticleTitlePercutaneous removal of retained intrahepatic stones with a pre-shaped angulated catheter: review of 96 patients Br J Radiol 65 9–13 Occurrence Handle1486378
NA Kimchi V Mindrul E Broide E Scapa (1998) ArticleTitleThe contribution of endoscopy and biopsy to the diagnosis of periampullary tumors Endoscopy 30 538–543 Occurrence Handle9746162
ME Lambert DF Martin DEF Tweedle (1988) ArticleTitleEndoscopic removal of retained stones after biliary surgery Br J Surg 75 896–898 Occurrence Handle3179668
JWC Leung VP Banez SCS Chung (1990) ArticleTitlePrecut (needle knife) papillotomy for impacted common bile duct stone at the ampulla Am J Gastroenterol 85 991–993 Occurrence Handle2375328
NJ Lygidakis (1983) ArticleTitleSurgical approaches to recurrent choledocholithiasis Am J Surg 145 633–639 Occurrence Handle10.1016/0002-9610(83)90110-1 Occurrence Handle6846702
E Mack EM Patzer AB Grummy AF Hofmann VK Babayan (1981) ArticleTitleRetained biliary tract stones Arch Surg 116 341–345 Occurrence Handle6162433
DF Martin DEF Tweedle (1984) ArticleTitleThe etiology and significance of distal choledochoduodenal fistula Br J Surg 71 632–634 Occurrence Handle6743988
CK McSherry F Glenn (1980) ArticleTitleThe incidence and causes of death following surgery for non-malignant biliary tract disease Ann Surg 191 271–275 Occurrence Handle7362293
R Mizumoto K Kire Y Ogur Y Sato (1980) ArticleTitlePathogenesis and treatment of recurrent gallstones Journal of Surgical Treatment (Japan) 42 131–137
JP Neoptolemos DL Carr-Locke I Fraser DP Fossard (1984) ArticleTitleThe management of common bile duct calculi by endoscopic sphincterotomy in patients with gallbladders in situ Br J Surg 71 69–71 Occurrence Handle6689976
H Neuhaus (1997) ArticleTitleWhich test for common bile duct stones? Endoscopic retrograde cholangiopancreatography Endoscopy 29 669–70 Occurrence Handle9360881
RK Tandon SA Nijhawan (1990) ArticleTitleManagement of retained bile duct stones in patients with T-tube in situ: role of endoscopic sphincterotomy Am J Gastroenterol 85 1126–1131 Occurrence Handle2389725
H Yoshimoto S Ikeda M Tanaka S Matsumoto Y Kuroda (1989) ArticleTitleCholedochoscopic electrohydraulic lithotripsy and lithotomy for stones in the common bile duct, intrahepatic ducts, and gallbladder Ann Surg 210 576–582 Occurrence Handle2818026
Acknowledgments
We gratefully thank Mrs. K. Moshota, the head nurse of our endoscopic unit, for her assistance during the procedures and for the collection of the patients' data.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Christoforidis, E., Vasiliadis, K., Goulimaris, I. et al. Endoscopic management of retained bile stones with an indwelling T-tube. Surg Endosc 18, 1582–1586 (2004). https://doi.org/10.1007/s00464-003-9272-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-003-9272-9