Short-term biliary stenting before mechanical lithotripsy for difficult bile duct stones

Short-term common bile duct stenting has been shown to decrease stone size, but its effect on mechanical lithotripsy has not been reported.

Sixty patients of difficult bile duct stones were subjected to mechanical lithotripsy. Thirty patients were subjected to mechanical lithotripsy at the time of first endoscopic retrograde cholangiopancreatography (group A) while another 30 patients were subjected to mechanical lithotripsy using trapezoid basket after a short period of stenting (group B). The effect on the hardness of stone, durability of the basket after stenting, and duration of mechanical lithotripsy was studied.

Lithotripsy after stenting was less time consuming, and durability of the basket was much more in comparison to lithotripsy without stenting (p < 0.001). Friability of stone increased after stenting, and it was easy to break the stone after preliminary stenting.

Short-term (2 to 3 months) stenting should be done in all the patients with large stones before subjecting them to mechanical lithotripsy to make the procedure less time consuming and more convenient to endoscopist.