Biliary stent placement without endoscopic sphincterotomy in patients with common bile duct stones

Background

To avoid the late complications of endoscopic sphincterotomy (EST) such as cholangitis, liver abscess and recurrent common bile duct stones (CBDS), alternative methods should be considered in the management of CBDS, especially in younger patients.

Aim

To study the effect of biliary stent placement without EST in patients with CBDS.

Methods

Forty-nine patients with CBDS underwent biliary stent placement without EST and complications were evaluated. The rate of stone disappearance, the change in number, size and indices of stones and common bile duct (CBD) diameter were evaluated at the second endoscopic retrograde cholangiopancreatography (ERCP) 3 months later.

Results

CBDS(s) disappeared in 11 (22.45%) of 49 patients. Almost all of the stones which disappeared after stenting without EST were <14 mm and CBD diameter <18 mm. Average diameter of the largest CBDS, mean number of CBDS, stone index and CBD diameter markedly reduced (P < 0.001, P < 0.001, P < 0.001 and P = 0.001 respectively). The size of the largest stone, stone indices and diameter of CBD in the stone disappearance cases were significantly smaller than those of the stone persistence cases (P = 0.003, P = 0.006, P = 0.004 respectively). Complications such as mild post-ERCP pancreatitis (6.12%), stent migration (10.2%) and cholangitis (4.08%) were observed.

Conclusion

Temporary stent placement without EST is effective for clearance of CBDS while preserving the duodenal papilla function, especially in small CBDS and less dilated CBD to avoid EST related complications.