BACKGROUND: The management of difficult lithiasis of common bile duct (CBD) often requires a multimodal approach. Fully Covered Metal Stents (FCSEMS) could fragment the stones, dilate strictures of the CBD and progressively enlarge the papillary orifice. The aim of the study was to evaluate the efficacy of FCSEMS in the treatment of difficult lithiasis of CBD. METHODS: All consecutive cases of difficult lithiasis of CBD after an attempt of clearance with complete sphincterotomy were retrospectively considered from 2009 to 2019. Intrahepatic lithiasis cases were excluded. Multivariable analysis (stepwise logistic regression if p value < 0.1 at univariable analysis) was made to understand factors associated with efficacy of FCSEMS in difficult lithiasis of CBD. RESULTS: 163 cases of difficult lithiasis over 1516 cases of lithiasis of CBD (incidence of 11%) were considered. Among eligible patients, 96 (mean age 78 ± 11.9 years, 43% males) placed a FCSEMS during the first ERCP. Mean diameter of stone was 17.5 ± 5.5 mm. An attempt of dilation during the same procedure was made in 18% cases. After removal of the stent, 52 (54%) patients had complete clearance of CBD at cholangiography. The rest of patients (44), subsequently underwent multimodal treatment (final success of 95%). After logistic regression, variables positively associated with clearance of CBD were sex male (OR 3.5) and stent permanence ≥ 30 days (OR 3.2). Diameter of the stone ≥ 2 cm was associated with failure (OR 0.2). 7 post-ERCP pancreatitis, 6 post-sphincterotomy bleeding and 3 cholangitis occurred. CONCLUSIONS: FCSEMS are useful in the approach of difficult lithiasis of CBD with no significant adverse events associated.
BACKGROUND: The management of difficult lithiasis of common bile duct (CBD) often requires a multimodal approach. Fully Covered Metal Stents (FCSEMS) could fragment the stones, dilate strictures of the CBD and progressively enlarge the papillary orifice. The aim of the study was to evaluate the efficacy of FCSEMS in the treatment of difficult lithiasis of CBD. METHODS: All consecutive cases of difficult lithiasis of CBD after an attempt of clearance with complete sphincterotomy were retrospectively considered from 2009 to 2019. Intrahepatic lithiasis cases were excluded. Multivariable analysis (stepwise logistic regression if p value < 0.1 at univariable analysis) was made to understand factors associated with efficacy of FCSEMS in difficult lithiasis of CBD. RESULTS: 163 cases of difficult lithiasis over 1516 cases of lithiasis of CBD (incidence of 11%) were considered. Among eligible patients, 96 (mean age 78 ± 11.9 years, 43% males) placed a FCSEMS during the first ERCP. Mean diameter of stone was 17.5 ± 5.5 mm. An attempt of dilation during the same procedure was made in 18% cases. After removal of the stent, 52 (54%) patients had complete clearance of CBD at cholangiography. The rest of patients (44), subsequently underwent multimodal treatment (final success of 95%). After logistic regression, variables positively associated with clearance of CBD were sex male (OR 3.5) and stent permanence ≥ 30 days (OR 3.2). Diameter of the stone ≥ 2 cm was associated with failure (OR 0.2). 7 post-ERCP pancreatitis, 6 post-sphincterotomy bleeding and 3 cholangitis occurred. CONCLUSIONS: FCSEMS are useful in the approach of difficult lithiasis of CBD with no significant adverse events associated.
Authors: Gianpiero Manes; Gregorios Paspatis; Lars Aabakken; Andrea Anderloni; Marianna Arvanitakis; Philippe Ah-Soune; Marc Barthet; Dirk Domagk; Jean-Marc Dumonceau; Jean-Francois Gigot; Istvan Hritz; George Karamanolis; Andrea Laghi; Alberto Mariani; Konstantina Paraskeva; Jürgen Pohl; Thierry Ponchon; Fredrik Swahn; Rinze W F Ter Steege; Andrea Tringali; Antonios Vezakis; Earl J Williams; Jeanin E van Hooft Journal: Endoscopy Date: 2019-04-03 Impact factor: 10.093
Authors: Earl Williams; Ian Beckingham; Ghassan El Sayed; Kurinchi Gurusamy; Richard Sturgess; George Webster; Tudor Young Journal: Gut Date: 2017-01-25 Impact factor: 23.059
Authors: Pier Alberto Testoni; Alberto Mariani; Lars Aabakken; Marianna Arvanitakis; Erwan Bories; Guido Costamagna; Jacques Devière; Mario Dinis-Ribeiro; Jean-Marc Dumonceau; Marc Giovannini; Tibor Gyokeres; Michael Hafner; Jorma Halttunen; Cesare Hassan; Luis Lopes; Ioannis S Papanikolaou; Tony C Tham; Andrea Tringali; Jeanin van Hooft; Earl J Williams Journal: Endoscopy Date: 2016-06-14 Impact factor: 10.093