Original communication| Volume 105, ISSUE 1, P51-56, January 1989

Large bile duct stones treated by biliary drainage

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      One hundred five patients with obstructive jaundice and cholangitis (49 patients), referred for diagnostic endoscopy, were found to have inextractable bile duct stones. Median age was 76 years and three quarters were more than 72 years of age. Insertion of an endoprosthesis with or without a sphincterotomy relieved jaundice in 94% and settled cholangitis in 90%. Antibiotic cover during the procedure seems essential inasmuch as pyrexia and septicemia occurred in 6 of 57 cases where it was not given. One case was lethal. Another patient died of acute pancreatitis. The patients were old. One quarter died before the follow-up, 1to 5 years after the initial intervention. The results indicate that the combination of endoscopic sphincterotomy, insertion of an endoprosthesis, and, if feasible, stone extraction on a later occasion when the acute phase of the illness had subsided brought the disease sufficiently under control among three quarters of the patients with large common duct stones or stenoses in the biliary tract. One quarter of the patients were treated surgically. This was accomplished without mortality, but morbidity was not negligible. A policy with a surgical approach restricted to selected cases with persistent symptoms in spite of sufficient endoscopic drainage is recommended.
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        • Classen M
        • Demling L
        Endoskopische Sphinkterotomie der Papilla Vateri und Steinextraction aus dem Ductus Choledochus.
        Dtsch Med Wochenschr. 1974; 99: 496-497
        • Classen M
        • Safrany L
        Endoscopic papillotomy and removal of gall stones.
        Br Med J. 1975; 99: 371-374
        • Safrany L
        Endoscopic treatment of biliary-tract diseases.
        Lancet. 1978; 2: 983-985
        • Cotton PB
        • Vallon AG
        British experience with duodenoscopic sphincterotomy for removal of bile duct stones.
        Br J Surg. 1981; 68: 373-375
        • Hatfield ARW
        Endoscopic sphincterotomy and gallstone removal.
        in: Motson RW Retained common duct stones. Grune and Stratton, London1985: 109-130
        • Nielsen ML
        • Justesen T
        Anaerobic and aerobic bacteriological studies in biliary tract disease.
        Scand J Gastroenterol. 1976; 11: 437-446
        • Kiil J
        • Kruse A
        • Rokkjaer M
        Endoscopic biliary drainage.
        Br J Surg. 1987; 74: 1087-1090
        • Lygidakis NJ
        • Brummelkamp WH
        Bacteria in relation to intrabiliary pressure in proximal v. distal malignant biliary obstruction.
        Acta Chir Scand. 1986; 152: 305-307
        • Houghton PWJ
        • Jenkinson LR
        • Donaldson LA
        Cholecystectomy in the elderly: a prospective study.
        Br J Surg. 1985; 72: 220-222
        • Sullivan DM
        • Ruffin-Hodd T
        • Griffin WO
        Biliary tract surgery in the elderly.
        Am J Surg. 1982; 143: 218-220
        • Martin DF
        • Tweedle DEF
        Endoscopic management of common duct stones without cholecystectomy.
        Br J Surg. 1987; 74: 209-211
        • Soehendra N
        • Reynders-Frederix V
        Palliative gallengangdrainage.
        Dtsch Med Wochenschr. 1979; 104: 602-603
        • Huibregtse K
        • Tytgat GN
        Palliative treatment of obstructive jaundice by transpapillary introduction of large bore bile duct endoprosthesis.
        Gut. 1982; 23: 371-375
        • Keighley MBR
        Microorganisms in the bile.
        Ann R Coll Surg Engl. 1977; 59: 329-334
        • Gregg JA
        • De Girolami P
        • Carr-Locke DL
        Effects of sphinctoroplasty and endoscopic sphincterotomy on the bacteriologic characteristics of the common bile duct.
        Am J Surg. 1985; 149: 668-671
        • Cotton PB
        Endoscopic management of bile duct stones (apples and oranges).
        Gut. 1984; 25: 587-597
        • Vellacott KD
        • Powel PH
        Exploration of the common bile duct: a comparative study.
        Br J Surg. 1979; 66: 389-391
        • Escourrou J
        • Cordova JA
        • Lazorthes F
        • Frexinos J
        • Ridet A
        Early and late complications after endoscopic sphincterotomy for lithiasis with and without the gallbladder in situ.
        Gut. 1984; 25: 598-602
        • Stubbs RS
        • Blumgart LH
        Exploration of the common bile duct.
        J R Coll Surg Edinb. 1984; 29: 76-80
        • Koch H
        • Rosch W
        • Schaffner O
        • Demling L
        Endoscopic papillotomy.
        Gastroenterology. 1977; 73: 1393-1396
        • Cotton PB
        • Vallon AG
        Duodenoscopic sphincterotomy for removal of bile duct stones in patients with gallbladders.
        Surgery. 1982; 91: 628-630
        • Solhaug JH
        • Fokstuen O
        • Rosseland A
        • Rydberg B
        Endoscopic papillotomy in patients with gallbladder in situ.
        Acta Chir Scand. 1984; 150: 475-478
        • Moss JG
        • Saunders JH
        • Wild SR
        Endoscopic papillotomy for removal of common bile duct stones without cholecystectomy.
        J R Coll Surg Edinb. 1985; 30: 112-124
        • Leese T
        • Neoptolemos JP
        • Carr-Locke DL
        Successes, failures, early complications and their management following endoscopic sphincterotomy: results in 394 consecutive patients from a single centre.
        Br J Surg. 1985; 72: 215-219
        • Johnson AG
        • Hosking SW
        Appraisal of the management of bile duct stones.
        Br J Surg. 1987; 74: 555-560
        • Thompson MH
        Influence of endoscopic papillotomy on the management of bile duct stones.
        Br J Surg. 1986; 73: 779-781
        • Larson RE
        • Hodgson JR
        • Priestley JT
        The early and long term results of 500 consecutive explorations of the common duct.
        Surg Gynecol Obstet. 1966; 122: 744-750
        • Lygidakis NJ
        A prospective randomised study of recurrent choledocholithiasis.
        Surg Gynecol Obstet. 1982; 155: 679-684