Clinical experience with endoscopic stents for treatment of common bile duct stones

Endoscopic removal of common bile duet (CBD) stones after endoscopic sphinc terotomy (EST) is now a widely accepted procedure. Surgery is usually recom mended when extraction of stones after EST fails. For patients with major m edical problems or who are at high surgical risk, however, endoscopic stent placement may help to prevent stone impaction and cholangitis. In this rep ort, we describe the long-term effects and complications of biliary stent u se in elderly patients with CBD stones. From August 1995 to June 1998, 19 p atients with CBD stones underwent stent placement by duodenoscopy. Three of these patients underwent this procedure fur temporary treatment while awai ting surgery or EST. In the remaining 16 patients (6 men and 10 women, mean age 76 +/- 10 years), invasive management carried a high risk of complicat ions. We used a 7F straight stent fur the first patient, while the remainin g 15 received 7F pigtail stents. During a mean follow-up period of 34 month s, two patients were lost to follow-up and two patients had migration of th e stents. Three patients had acute cholangitis with stents in situ. Of thes e, one underwent stent exchange 8 months later, while the CBD stones were c leared either by endoscopy or surgery in the other two patients. Five patie nts died of nonbiliary diseases during the follow-up period. Out results sh ow; that long-term biliary stent placement is an advisable alternative ther apeutic modality for high-risk and debilitated patients with CBD stories.