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Salama et al  

Full Length Research Paper

Treatment of Large and Difficult Common Bile duct Stones using Endoscopic Plastic Stenting


*Mostafa Mahmoud Salama, Aly Ragab, Walid Rafat Abdelaty, Yasser Hussein, Mohammed Hassan Elshafey

Department of General Surgery, Al-Azhar University Hospitals, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.


Corresponding author email: mostafa_slama_2015@yahoo.com; Tel: + 20 1110816308

Received November 23, 2017; Accepted December 12, 2017


Plastic stents inserted during ERCP is a common procedure for establishing biliary drainage in patients with large stones. As there is no definite evidence for the effect of plastic stents on stone size, this study was conducted to throw a light on this issue comparing stone size before and months after stent insertion. Plastic biliary stenting was performed during endoscopic retrograde cholangiopancreatography (ERCP) for 20 patients who had huge common bile duct stones or those difficult to remove with balloon or dormia basket. The diameter of stones was 15 mm in all patients. Sphincterotomy, and endoscopic placement of 10 Fr plastic biliary stents were established in all patients. Comparison of stone size before and 6 months after stent insertion were documented. The complete stone clearance rate after treatment was obtained. After plastic stent insertion for 3–6 months, the biliary stones were absent or became sludge in 4 (4/20) patients, and reduction in stone sizes became evident in 15 patients, in whom the stone median size was significantly decreased from 23.1 mm to 15.4 mm. The biliary passages were cleared from stones in 18 (18/20) patients, either due to their change to sludge (4 patients), or the stones were extracted successfully with basket, balloon or a combination (in 14 patients). The remaining two patients (2/20) demonstrated no significant changes in stone sizes. Plastic biliary stenting may destroy common bile duct stones and reduce their sizes. This is an effective and applicable alternative to clear large or difficult common bile duct stones

Large Stones, Endoscopic Retrograde Cholangiopancreatography, Plastic Stent.


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