Endoscopic treatment of difficult choledocholithiasis

Area of Science:

• Gastroenterology
• Endoscopic Surgery

Background:

• Common bile duct stones (choledocholithiasis) can obstruct bile flow.
• Standard endoscopic techniques may fail for large, numerous, or impacted stones, or in cases of bile duct stenosis.
• Effective management is crucial to prevent complications like cholangitis and pancreatitis.

Purpose of the Study:

• To evaluate the efficacy and safety of endoscopic plastic stent placement for difficult common bile duct stones.
• To assess the outcomes of patients requiring stenting due to unsuccessful stone removal or bile duct stenosis.

Main Methods:

• Retrospective analysis of patients with difficult choledocholithiasis treated with endoscopic plastic stent placement.
• Assessment of stone removal rates, clinical improvement, and complications at three-month follow-up.
• Evaluation of the need for permanent stenting and overall procedure safety.

Main Results:

• Complete stone removal was achieved in 85.4% (41/48) of patients with difficult choledocholithiasis.
• The remaining 14.6% (7/48) of patients showed clinical improvement with stent placement.
• Four patients required a permanent stent for safe bile drainage without complications.
• Endoscopic stent placement was effective in all cases with no reported complications.

Conclusions:

• Endoscopic plastic stent insertion is a safe and effective strategy for managing difficult common bile duct stones.
• Stenting facilitates rapid bile drainage and clinical improvement, offering a valuable alternative when stone removal is challenging.
• This endoscopic approach provides a low-complication solution for choledocholithiasis refractory to standard endoscopic removal.