Double Plastic Stents as a Bridging Strategy for Large Common Bile Duct Stones: A Case Report of Two Patients.

Abstract

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is the standard treatment for common bile duct (CBD) stones. However, in 10-15% of cases involving large or multiple stones, this approach is inadequate. Advanced techniques such as lithotripsy, dilation, balloon extraction, or surgery may be required.

Case presentation: We present 2 post-cholecystectomy patients with large (>1.5 cm), multiple impacted CBD stones. Initial ERCP attempts, including sphincterotomy and 15-mm balloon dilation, failed to clear the stones. As a bridging strategy, two plastic stents (10 Fr and 7 Fr) were placed, and ursodeoxycholic acid therapy was started. On re-evaluation at 50 and 80 days, stone clearance was achieved using simple balloon extraction - without lithotripsy or cholangioscopy - using the same tools as the initial ERCP.

Conclusion: Double plastic stent placement can serve as an effective interim measure for complex CBD stones, facilitating complete clearance in subsequent ERCP with standard equipment.