Shou-jiang Tang1, Luis Armstrong, Luis F Lara, Paul Kortan. 1. Division of Digestive Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8887, USA, and Center for Therapeutic Endoscopy and Endoscopic Oncology, St Michael's Hospital, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Long-term and permanent biliary stenting have been reported in many studies and are infrequently practiced in selected patients with irretrievable common bile duct stones and biliary strictures. PATIENTS: Here we report 3 new cases and review 7 other cases of de novo stent-stone complex formation after long-term biliary stent placement. INTERVENTIONS: De novo stent-stone complexes developed in 3 young patients after unintended long-term biliary stent placement of 4.5 to 11 years' duration. The stent-stone complexes were successfully removed during ERCP with electrohydrolic lithotripsy (EHL) in combination with choledochoscopy or extracorporeal shock wave lithotripsy (ESWL) with mechanical lithotripsy (ML). RESULTS: The de novo radiolucent stones formed around and above the stent in the proximal and end part of the stent. The stones were generally large with a diameter>2 to 3 cm. The stent-stone complex usually assumed a 1-sided dumbbell configuration inside the bile duct. The mean duration to clinical presentation after initial biliary stenting is 5.64 years (range 2-11 years). CONCLUSIONS: It is important to keep in mind that a biliary stent can act as a nidus for new biliary stone formation around the stent after long-term placement. We recommend that the optimal endotherapy in this situation is ML for the free-floating complexes with short stents, and choledochoscopy with EHL or laser lithotripsy and ESWL for impacted complexes with longer stents.
BACKGROUND: Long-term and permanent biliary stenting have been reported in many studies and are infrequently practiced in selected patients with irretrievable common bile duct stones and biliary strictures. PATIENTS: Here we report 3 new cases and review 7 other cases of de novo stent-stone complex formation after long-term biliary stent placement. INTERVENTIONS: De novo stent-stone complexes developed in 3 young patients after unintended long-term biliary stent placement of 4.5 to 11 years' duration. The stent-stone complexes were successfully removed during ERCP with electrohydrolic lithotripsy (EHL) in combination with choledochoscopy or extracorporeal shock wave lithotripsy (ESWL) with mechanical lithotripsy (ML). RESULTS: The de novo radiolucent stones formed around and above the stent in the proximal and end part of the stent. The stones were generally large with a diameter>2 to 3 cm. The stent-stone complex usually assumed a 1-sided dumbbell configuration inside the bile duct. The mean duration to clinical presentation after initial biliary stenting is 5.64 years (range 2-11 years). CONCLUSIONS: It is important to keep in mind that a biliary stent can act as a nidus for new biliary stone formation around the stent after long-term placement. We recommend that the optimal endotherapy in this situation is ML for the free-floating complexes with short stents, and choledochoscopy with EHL or laser lithotripsy and ESWL for impacted complexes with longer stents.