[Nonsurgical treatment of bile duct stones]

Despite advances in intraoperative choledochoscopy and cholangiography, it is still common for bile duct stones to remain after common bile duct (CBD) exploration. The incidence of bile duct calculi in those undergoing cholecystectomy ranges from 7-15%, and that of retained stones immediately after CBD exploration, from 10-13%. Re-exploration carries a postoperative mortality varying from 3-28%. Treatment by T-tube flushing with heparinized saline, cholate or mono-octanoin is of limited value. Flushing with methyltertiarybutyl ether via a nasobiliary drain was recently reported to be successful in 80%, but confirmation of its efficacy and lack of toxicity is still pending. Continuous infusion via a nasobiliary tube of modified mono-octanoin alternating with EDTA solution may dissolve calcium bilirubin stones. Endoscopic sphincterotomy is successful in 95%. Extraction of CBD stones by either basket or balloon catheter is possible in 85-90% of cases at the time of endoscopic sphincterotomy. Large stones remaining are treated by mechanical lithotripsy with a success rate of 82%, which raises the overall success rate of endoscopic CBD stone extraction after endoscopic sphincterotomy to 97%. However, when stones exceed 25 mm in diameter, the success rate is lower. Electrohydraulic lithotripsy (EHL) may damage the CBD wall because the exact site of spark discharge is under fluoroscopic, not direct endoscopic control. In the near future, applying EHL under direct vision via peroral cholangioscopy should decrease the hazards of this method.(ABSTRACT TRUNCATED AT 250 WORDS)