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

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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.

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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.

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Correspondence to E. Christoforidis.

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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

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