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

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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.

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References

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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. 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.

    Article  PubMed  CAS  Google Scholar 

  8. Duensing RA, Williams RA, Collins JC, Wilson SE. Managing choledocholithiasis in the laparoscopic era. Am J Surg. 1995;170:619–623.

    Article  PubMed  CAS  Google Scholar 

  9. Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909–918.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  13. Ando T, Tsuyuguchi T, Okugawa T, et al. Risk factors for recurrent bile duct stones after endoscopic papillotomy. Gut. 2003;52:116–121.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  17. Boey JH, Way LW. Acute cholangitis. Ann Surg. 1980;191:264–270.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  19. O’Connor MJ, Schwartz ML, McQuarrie DG, Sumer HW. Acute bacterial cholangitis: an analysis of clinical manifestation. Arch Surg. 1982;117:437–441.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea

    Sang Eon Jang, Dong-Won Ahn, Sang Hyub Lee, Ban Seok Lee, Ji Bong Jeong, Jin-Hyeok Hwang, Ji Kon Ryu & Yong-Tae Kim

  2. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea

    Sang Hyub Lee, Ji Kon Ryu & Yong-Tae Kim

  3. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoungnam-si, Gyeonggi-do, Korea

    Sang Eon Jang, Sang Hyub Lee, Ban Seok Lee & Jin-Hyeok Hwang

  4. Department of Internal Medicine, Cheongju St. Mary’s Hospital, Cheongju, Korea

    Sang Eon Jang

  5. Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea

    Dong-Won Ahn & Ji Bong Jeong

  6. Department of Internal Medicine, Cheju Halla General Hospital, Jeju, Korea

    Ban Seok Lee

  7. Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoungnam-si, Gyeonggi-do, Korea

    Kyoung Ho Lee & Young Hoon Kim

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  1. Sang Eon Jang
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  2. Dong-Won Ahn
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  9. Kyoung Ho Lee
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Corresponding author

Correspondence to Sang Hyub Lee.

Additional information

Sang Eon Jang and Dong-Won Ahn contributed equally to this work as first authors.

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Jang, S.E., Ahn, DW., Lee, S.H. et al. Preventive Saline Irrigation of the Bile Duct After the Endoscopic Removal of Common Bile Duct Stones. Dig Dis Sci 58, 2353–2360 (2013). https://doi.org/10.1007/s10620-013-2647-4

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  • DOI: https://doi.org/10.1007/s10620-013-2647-4

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