TREATMENT OPTIONS FOR LARGE COMMON BILE-DUCT STONES

This is a retrospective analysis of the medical records of patients di agnosed to have large common bile duct stones (greater than or equal t o 15 mm). The study was designed to evaluate different modalities of l arge bile duct stone treatment. The setting is King Khalid University Hospital, Gastroenterology Unit. The medical records of patients (n=64 ) diagnosed to have large common bile duct stones by endoscopic retrog rade cholangiography over a period of nine years were included. Files were reviewed and information obtained which included patients' age, s ex, nationality, presenting symptoms, number and size of bile duct sto nes, presence of ascending cholangitis, mode of treatment received, co mplications and outcome. There were a total of 64 patients; 28 males a nd 36 females, with a mean age of 61 +/- 16.6 years. Successful stone extraction was achieved in 44 (69%) patients while surgical treatment was required in 20 patients. Surgically managed patients had significa ntly larger stones (P<0.003) and were more frequently jaundiced (P<0.0 14). There was 7.8% of the total number of patients who developed comp lications that were managed conservatively with full recovery. It was concluded that large stones are difficult to extract endoscopically an d more frequently require additional treatment.