TREATMENT OF NON-EXTRACTABLE COMMON BILE-DUCT STONES WITH COMBINATIONURSODEOXYCHOLIC ACID PLUS ENDOPROSTHESES

Despite widely available,technology for removal of bile duct stones, e ndoscopists currently encounter approximately 3% of patients with ston es that defy extraction. After sphincterotomy and unsuccessful attempt s at extraction of ''defiant'' stones, biliary stents were placed in 2 2 patients. Ten patients were treated with ursodeoxycholic acid, and 1 2 patients treated only with stent served as control subjects. Ductal strictures preventing stone extraction were present in eight control p atients and in six patients treated with ursodeoxycholic acid. The num ber of total calculi in the ursodeoxycholic acid group was slightly hi gher (4.2 per patient) than the number in the control group (3.3 per p atient). Stone and bile duct dimensions were similar in each group. Ni ne of 10 patients in the ursodeoxycholic acid group had complete stone clearance, and 41 of 42 stones were removed during a follow-up period of 9 +/- 2 months; in contrast, no patient in the control group had c omplete clearance and only 6 of 40 stones were removed after a follow- up period of 31 +/- 6 months. Oral ursodeoxycholic acid facilitates ex traction of defiant bile duct stones. This treatment is an effective a lternative to high-tech extraction methods for large biliary stones.