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

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.

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.

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