ENDOSCOPIC LITHOTOMY OF COMMON BILE-DUCT STONES WITH SUBLINGUAL NITROGLYCERIN AND GUIDEWIRE

Objective: In 21 patients, our objective was the endoscopic removal of common bile duct stones by sphincter dilation with the application of sublingual nitroglycerin. Methods: Nitroglycerin 0.3-0.6 mg was neede d for proper dilation of the orifice and for successful cannulation of the Dormia basket into the bile duct. Cannulation of the Dormia baske t was simplified by placing the guidewire in the common bile duct befo rehand. Because of possible stone impaction, a mechanical lithotriptor was applied smoothly in two patients. Results: Complete stone removal was successful in 18 of the 21 (86%) patients. One patient who develo ped a mild form of acute pancreatitis recovered in a few days by conse rvative management with drip infusion of protease inhibitor. Blood pre ssure dropped transiently in a patient receiving nitroglycerin, but th e general condition of the patient was stable. Conclusions: This proce dure was found to be safe, easy, and effective in extracting common bi le duct stones.