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PubMedDate not supplied

Choledocholithiasis treated by ethylenediaminetetraacetic acid infusion through an endoscopic nasobiliary catheter.

A 64 year old man was admitted to the National Cheng Kung University Hospital for obstructive jaundice. He had received cholecystectomy 5 years previously. Sonography revealed common bile duct stones. He was treated with endoscopic nasobiliary drainage (ENBD) for 5 days for concomitant cholangitis. The muddy pigment stones disappeared completely after 10 days of infusion of ethylenediaminetetraacetic acid (EDTA) via the ENBD tube. There were no adverse effects, and he was stone-free 4 months later.

Catheters, Indwelling↗
PubMed1994

Appraisal of surgical and endoscopic management of choledocholithiasis.

One hundred and ten patients with common bile duct (CBD) stones were treated in the Department of Surgical Gastroenterology at SGPGIMS, Lucknow, India between January 1989 and December 1992. The primary modality of treatment was surgery in 62 patients (group I) and endoscopic sphincterotomy (ES) in 48 (group II). The two groups were well matched with respect to clinical features and presence of medical risk factors. Surgical clearance of CBD stones was achieved in 58 patients (93.5%; group Ia). Four patients (7%) had retained stones following surgery (group Ib). In group II, the CBD was cleared by endoscopic means in 20 out of 48 patients (42%) and was categorized into group IIa. In the remaining patients ES was followed by CBD exploration (group IIb). Significantly higher morbidity was seen in patients needing CBD surgery following attempted endoscopic clearance, because of ES-related complications, such as bleeding, cholangitis, septicaemia and numerous others. Use of ES to treat CBD stones on a routine basis was therefore not found to be any better than one-time surgical exploration.

Adult↗
PubMed1996

Choledocholithiasis in anomalous biliary system.

Although congenital biliary abnormalities are common, preduodenal portal vein is very rare, not to mention preduodenal common bile duct (CBD) which has not been described before in the literature. A case with both anomalies complicated by biliary tract stones is reported. A brief review of embryonic development is also presented to explain the unusual biliary anatomy of this patient.

Adult↗
PubMed1988

Choledocholithiasis--in vivo stone dissolution using methyl tertiary butyl ether (MTBE).

We report a series of 10 elderly patients with large bile duct calculi refractory to standard endoscopic extraction techniques who were treated by gall stone dissolution using methyl tertiary butyl ether (MTBE) instilled through a nasobiliary catheter. In eight patients complete bile duct clearance was achieved after an average of eight hours MTBE instillation. In two patients gall stone size did not change. Both underwent operative gall stone removal and subsequent stone analysis showed low cholesterol content, which is unlikely to respond to MTBE. Apart from occasional transient nausea and drowsiness, no adverse reactions were noted. Methyl tertiary butyl ether appears to be a powerful in vivo gall stone dissolution agent which, from preliminary studies, is not associated with serious toxicity.

Aged↗
PubMed1998

Common bile duct stenting for choledocholithiasis: a district general hospital experience.

The favoured treatment of common bile duct stones is endoscopic sphincterotomy and stone extraction. The management of those cases where duct clearance is not possible is controversial. At our institution it has been policy to insert an endoluminal stent. We report a retrospective review of the outcome of patients stented for common bile duct stones. The study population was 14 men and 22 women, with a median age of 73 years (range 23-89 years). Treatment-related morbidity was seen in nine patients (25%), comprising cholangitis (5), pancreatitis (3), and cholecystitis (1). Three of these patients died; all were over the age of 75 years and had been stented on a long-term basis. These data suggest that endobiliary stents can be employed with an acceptable complication rate. We suggest that patients under the age of 75 years be stented only as a temporising measure, but that patients over 75 years or those unfit on physiological grounds can be stented on a long-term basis as definitive treatment.

Adult↗
PubMed1992

Standard surgical approaches to primary choledocholithiasis--definitive versus temporary decompression.

The occurrence of retained/recurrent calculi after primary CBDE followed by temporary T-tube decompression, have remained at rates varying from 5.4% to 20.9% over the last 10 years in spite of sophisticated pre and intraoperative imaging techniques. It is postulated that a functional obstruction, due to dysmotility of the SO, lies behind most stone-containing ducts. Thus it seems logical to us that a permanent "fenestration" should be the management of most such ducts. We prospectively followed-up, for one to 10 years, two groups of patients submitted to primary CBDE aiming to assess the short and long-term results of two different surgical approaches to duct lithiasis. In one (Group A) 162 CBDE's were performed, out of 680 CHE's (24%), with a "positivity" of 68% and in the other (Group B) 80 CBDE's, out of 438 CHE's (18%), with a "positivity" of 70%. In Group A a T-tube decompression was used in 79(49%) and a definitive drainage in 83(51%) whereas in Group B the T-tube was employed in only 3(4%) and some form of permanent "fenestration" in 77(96%). There were no significant differences between the operative mortality rates, which were 2.5% in Group A (1 death post T-tube, 3 post CDJ) and 1.3% in Group B (1 death post CDD). The long-term results, though, were significantly worse among patients of Group A whose ducts were temporarily decompressed: 10/79 (12.7%) required further aggressive interventional therapy for retained/recurrent stones while only 3.8% (3/80) in Group A and 1.3% (1/76) in Group B required revisional surgery for bilio-digestive anastomotic complications with cholangitis. It is concluded that it is against the long-term efficiency of the approach utilized in Group B that the new laparoscopic techniques should be compared.

Adult↗