Advertisement

Digestive Diseases and Sciences

, Volume 58, Issue 8, pp 2353–2360 | Cite as

Preventive Saline Irrigation of the Bile Duct After the Endoscopic Removal of Common Bile Duct Stones

  • Sang Eon Jang
  • Dong-Won Ahn
  • Sang Hyub Lee
  • Ban Seok Lee
  • Ji Bong Jeong
  • Jin-Hyeok Hwang
  • Ji Kon Ryu
  • Yong-Tae Kim
  • Kyoung Ho Lee
  • Young Hoon Kim
Original Article

Abstract

Background

Small stone fragments after an endoscopic stone extraction for choledocholithiasis may act as the nidus for recurrent choledocholithiasis. Therefore, efforts to eliminate the nidus might reduce the recurrence of choledocholithiasis and cholangitis related to choledocholithiasis.

Aims

The purpose of this study was to determine whether an additional preventive saline irrigation of the bile duct after the endoscopic removal of common bile duct stones would decrease residual stones and the recurrence of cholangitis.

Methods

A retrospective analysis was performed for the consecutively collected data about the patients who underwent the complete endoscopic treatment for common bile duct stone.

Results

Among 99 patients, 45 patients underwent saline irrigation. Residual stones were detected in 18 patients (18.2 %). The incidences of residual stones were 8.9 % (4 of 45 patients) in the irrigation group and 25.9 % (14 of 54 patients) in the non-irrigation group (P = 0.037). In multivariate analysis, preventive saline irrigation was found to be the only significant factor for the decrease of residual stones (HR = 0.258, P = 0.039). When analyzing the occurrence of recurrent cholangitis and the procedure related to complications, there were no significant differences according to the performance of preventive saline irrigation of the bile duct.

Conclusions

Preventive saline irrigation could reduce the residual common bile duct stones without complications.

Keywords

Saline irrigation Common bile duct stone Cholangitis Residual stone 

Notes

Conflict of interest

None.

References

  1. 1.
    Maple JT, Ben-Menachem T, Anderson MA, et al. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc. 2010;71:1–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Tse F, Liu L, Barkun AN, Armstrong D, Moayyedi P. EUS: a meta-analysis of test performance in suspected choledocholithiasis. Gastrointest Endosc. 2008;67:235–244.PubMedCrossRefGoogle Scholar
  3. 3.
    Escourrou J, Cordova JA, Lazorthes F, Frexinos J, Ribet A. Early and late complications after endoscopic sphincterotomy for biliary lithiasis with and without the gall bladder ‘in situ’. Gut. 1984;25:598–602.PubMedCrossRefGoogle Scholar
  4. 4.
    Schneider MU, Matek W, Bauer R, Domschke W. Mechanical lithotripsy of bile duct stones in 209 patients–effect of technical advances. Endoscopy. 1988;20:248–253.PubMedCrossRefGoogle Scholar
  5. 5.
    Davidson BR, Neoptolemos JP, Carr-Locke DL. Endoscopic sphincterotomy for common bile duct calculi in patients with gall bladder in situ considered unfit for surgery. Gut. 1988;29:114–120.PubMedCrossRefGoogle Scholar
  6. 6.
    Eckhauser FE, Raper SE, Knol JA, et al. Extracorporeal lithotripsy. An important adjunct in the nonoperative management of retained or recurrent bile duct stones. Arch Surg. 1991;126:829–834; discussion 834–835.Google Scholar
  7. 7.
    Cotton PB, Geenen JE, Sherman S, et al. Endoscopic sphincterotomy for stones by experts is safe, even in younger patients with normal ducts. Ann Surg. 1998;227:201–204.PubMedCrossRefGoogle Scholar
  8. 8.
    Duensing RA, Williams RA, Collins JC, Wilson SE. Managing choledocholithiasis in the laparoscopic era. Am J Surg. 1995;170:619–623.PubMedCrossRefGoogle Scholar
  9. 9.
    Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909–918.PubMedCrossRefGoogle Scholar
  10. 10.
    Prat F, Malak NA, Pelletier G, et al. Biliary symptoms and complications more than 8 years after endoscopic sphincterotomy for choledocholithiasis. Gastroenterology. 1996;110:894–899.PubMedCrossRefGoogle Scholar
  11. 11.
    Hawes RH, Cotton PB, Vallon AG. Follow-up 6 to 11 years after duodenoscopic sphincterotomy for stones in patients with prior cholecystectomy. Gastroenterology. 1990;98:1008–1012.PubMedCrossRefGoogle Scholar
  12. 12.
    Cheon YK, Lehman GA. Identification of risk factors for stone recurrence after endoscopic treatment of bile duct stones. Eur J Gastroenterol Hepatol. 2006;18:461–464.PubMedCrossRefGoogle Scholar
  13. 13.
    Ando T, Tsuyuguchi T, Okugawa T, et al. Risk factors for recurrent bile duct stones after endoscopic papillotomy. Gut. 2003;52:116–121.PubMedCrossRefGoogle Scholar
  14. 14.
    Cairns SR, Dias L, Cotton PB, Salmon PR, Russell RC. Additional endoscopic procedures instead of urgent surgery for retained common bile duct stones. Gut. 1989;30:535–540.PubMedCrossRefGoogle Scholar
  15. 15.
    Tsuchiya S, Tsuyuguchi T, Sakai Y, et al. Clinical utility of intraductal US to decrease early recurrence rate of common bile duct stones after endoscopic papillotomy. J Gastroenterol Hepatol. 2008;23:1590–1595.PubMedCrossRefGoogle Scholar
  16. 16.
    Ang TL, Teo EK, Fock KM, Lyn Tan JY. Are there roles for intraductal US and saline solution irrigation in ensuring complete clearance of common bile duct stones? Gastrointest Endosc. 2009;69:1276–1281.PubMedCrossRefGoogle Scholar
  17. 17.
    Boey JH, Way LW. Acute cholangitis. Ann Surg. 1980;191:264–270.PubMedCrossRefGoogle Scholar
  18. 18.
    Csendes A, Diaz JC, Burdiles P, Maluenda F, Morales E. Risk factors and classification of acute suppurative cholangitis. Br J Surg. 1992;79:655–658.PubMedCrossRefGoogle Scholar
  19. 19.
    O’Connor MJ, Schwartz ML, McQuarrie DG, Sumer HW. Acute bacterial cholangitis: an analysis of clinical manifestation. Arch Surg. 1982;117:437–441.PubMedCrossRefGoogle Scholar
  20. 20.
    Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37:383–393.PubMedCrossRefGoogle Scholar
  21. 21.
    Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol. 2001;96:417–423.PubMedCrossRefGoogle Scholar
  22. 22.
    Isogai M, Yamaguchi A, Harada T, Kaneoka Y, Suzuki M. Cholangitis score: a scoring system to predict severe cholangitis in gallstone pancreatitis. J Hepatobiliary Pancreat Surg. 2002;9:98–104.PubMedCrossRefGoogle Scholar
  23. 23.
    Raraty MG, Finch M, Neoptolemos JP. Acute cholangitis and pancreatitis secondary to common duct stones: management update. World J Surg. 1998;22:1155–1161.PubMedCrossRefGoogle Scholar
  24. 24.
    Ohashi A, Ueno N, Tamada K, et al. Assessment of residual bile duct stones with use of intraductal US during endoscopic balloon sphincteroplasty: comparison with balloon cholangiography. Gastrointest Endosc. 1999;49:328–333.PubMedCrossRefGoogle Scholar
  25. 25.
    Endo T, Ito K, Fujita N, et al. Intraductal ultrasonography in the diagnosis of bile duct stones: when and whom? Dig Endosc. 2011;23:173–175.Google Scholar
  26. 26.
    Andriulli A, Loperfido S, Napolitano G, et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol. 2007;102:1781–1788.PubMedCrossRefGoogle Scholar
  27. 27.
    Costamagna G, Tringali A, Shah SK, Mutignani M, Zuccala G, Perri V. Long-term follow-up of patients after endoscopic sphincterotomy for choledocholithiasis, and risk factors for recurrence. Endoscopy. 2002;34:273–279.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Sang Eon Jang
    • 1
    • 3
    • 4
  • Dong-Won Ahn
    • 1
    • 5
  • Sang Hyub Lee
    • 1
    • 2
    • 3
  • Ban Seok Lee
    • 1
    • 3
    • 6
  • Ji Bong Jeong
    • 1
    • 5
  • Jin-Hyeok Hwang
    • 1
    • 3
  • Ji Kon Ryu
    • 1
    • 2
  • Yong-Tae Kim
    • 1
    • 2
  • Kyoung Ho Lee
    • 7
  • Young Hoon Kim
    • 7
  1. 1.Department of Internal Medicine and Liver Research InstituteSeoul National University College of MedicineSeoulKorea
  2. 2.Department of Internal MedicineSeoul National University College of Medicine, Seoul National University HospitalSeoulKorea
  3. 3.Department of Internal MedicineSeoul National University College of Medicine, Seoul National University Bundang HospitalSeoungnam-siKorea
  4. 4.Department of Internal MedicineCheongju St. Mary’s HospitalCheongjuKorea
  5. 5.Department of Internal MedicineSeoul National University Boramae Medical CenterSeoulKorea
  6. 6.Department of Internal MedicineCheju Halla General HospitalJejuKorea
  7. 7.Department of Radiology, Seoul National University College of MedicineSeoul National University Bundang HospitalSeoungnam-siKorea

Personalised recommendations