Nonsurgical treatment of common-bile-duct stones

Exploration of the common bile duct, the traditional treatment for choledocholithiasis, can often be replaced by nonsurgical procedures. Since 1976, 147 patients have been treated nonsurgically with an overall success rate of 84%. Three groups are reported. In group 1, 80 patients had stone extraction under radiologic control through the T-tube tract alone. Stones were successfully removed from the common bile duct in 52 of 59 patients and from the intrahepatic ducts in 12 of 21 patients. The overall success rate of extraction through the T tube was 80%. Group 2 comprised 58 patients who underwent endoscopic sphincterotomy and stone extraction only with 86% success. The nine patients in group 3 required a combination of radiologic and endoscopic intervention. Six had stones "pushed" by the radiologist through a previously sphincterotomized ampulla of Vater and in two the radiologist introduced stone crushers transhepatically into the common duct to break up large stones to a size capable of passing through the sphincterotomy site (100% success). One elderly patient had a cholecystostomy under local anesthesia for suppurative cholecystitis, and subsequently multiple common-bile-duct stones were removed by the radiologist through the gallbladder and cystic duct and by the endoscopist through the endoscopic sphincterotomy site. All procedures were carried out under local anesthesia, and most required a hospital stay of 1 day or less. Complications were minimal and there were no deaths. T-tube extraction and endoscopic sphincterotomy are effective, relatively safe, nonsurgical procedures for the removal of common-duct stones.