Endoscopic endoprosthesis for large stones in the common bile duct.

Endoscopic biliary endoprosthesis was performed for 34 high-risk patients with common bile duct stones too large to be extracted by conventional endoscopic means. Bile duct drainage was established in all the patients without complications. Late complications developed in four patients and included cholangitis (three) and biliary pain (one). Twenty-five patients underwent a second endoscopic retrograde cholangiopancreatography between 4 and 30 months (mean, 15.1) during follow-up. Stone fragmentation was obtained in 76% (19/25) of the patients. Ten patients had complete stone clearance, and nine patients had disintegrated stones which could be readily removed endoscopically. The remaining nine patients were followed up with endoprostheses in situ for four to 60 months (mean, 24.8) without any symptoms. These results suggest that endoscopic endoprosthesis for difficult common bile duct stones is an effective method to clear the duct in selected cases, as well as an important definitive treatment in high-risk patients.