ENDOSCOPIC MANAGEMENT OF COMMON BILE DUCT STONES EXPERIENCE AT MILITARY HOSPITAL, RAWALPINDI

Endoscopic Management of Bile Duct Stones

Abstract

Objective: To determine the characteristics of patients presenting with common bile duct (CBD) stones, to know the type of endoscopic therapy employed and to see procedure related complications.
Study design: A descriptive study
Palace and Duration of Study: The study was conducted in the Department of Gastroenterology of Military Hospital , Rawalpindi from Jan 2007 to Dec 2007.
Methods: Adult patients with common bile duct stones who underwent endoscopic retrograde cholangiopancreatography (ERCP) enrolled in a consecutive manner. The procedure was done under sedation with midazolam and meperidine after informed and written consent. Patients data was obtained from the department and entered on a spread sheet to calculate percentages and frequencies .The data was analyzed using Statistical Package for Social Sciences ( SPSS ) version 10 to document the endoscopic procedures done and the procedure- related complications.
Results: Two hundred and twenty five patients underwent ERCP for evaluation and treatment of CBD stones. Mean age was 45 years with female to male ratio of 1.9 : 1. Out of 225 patients, cannulation failed in 4 cases due to duodenal stenosis and 154 ( 70 % ) out of 221 cases of CBD stones mandated endoscopic treatment with balloon trail, basket extraction, placement of plastic biliary stent temporarily or use of mechanical lithotriptor. Duct clearance was achieved in 67 % cases. Complication rate has been 9 % with bleeding being the most common complication with no mortality.
Conclusion: A duct clearance rate of over 67 % was achieved with sphincterotomy combined with balloon trail, basket extraction and lithotripsy. Bleeding was the most common procedure- related complication. Very large CBD stones/ Mirrizi syndrome cases were referred for surgical intervention.