Document Detail


Effect of biliary stenting combined with ursodeoxycholic acid and terpene treatment on retained common bile duct stones in elderly patients: a multicenter study.
MedLine Citation:
PMID:  19568225     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: For frail, elderly patients with large impacted common bile duct (CBD) stones, long-term treatment with biliary stenting provides palliation. Biliary stenting with choleretic agents such as ursodeoxycholic acid (UDCA) and terpene preparations may promote CBD stone size reduction. We studied the effectiveness of biliary stenting combined with UDCA and a terpene preparation as a medical treatment for difficult-to-remove CBD stones in patients older than 65 years in this multicenter, prospective study. METHODS: A total of 28 elderly patients with CBD stones refractory to conventional endoscopic removal, including mechanical lithotripsy, underwent endoscopic placement of a straight 10-F plastic biliary stent. Each patient was administered 600 mg of UDCA and 300 mg of a terpene preparation daily for a mean of 6 months. After 6 months of medication following the initial endoscopic retrograde cholangiopancreatography (ERCP), a second ERCP was performed and endoscopic stone removal was again attempted. Differences in stone size and CBD diameter before and after biliary stenting and medication were compared. The complete stone removal rate after treatment was obtained. RESULTS: The mean size (transverse x longitudinal diameter) of the CBD stones was initially 21.6 x 29.5 mm, and it decreased significantly to 12.2 x 20.1 mm at the second ERCP (P<0.01). The mean CBD diameter measured initially at the cystic duct insertion level was 23.2 mm, and it decreased significantly to 19.5 mm at the second ERCP (P<0.01). After biliary stenting with medication, endoscopic stone removal was successful in 26 of 28 patients (92.8%), with a mean of 1.7 subsequent ERCP sessions. CONCLUSIONS: Endoscopic biliary stenting with a period of combined UDCA and terpene preparation administration seems to be a safe and effective method for retained CBD stones in elderly patients. A prospective study with randomization and a control group is required to confirm these results.
Authors:
Jimin Han; Jong Ho Moon; Hyun Cheol Koo; Jee Heon Kang; Joon Hyuck Choi; Seok Jeong; Don Haeng Lee; Moon Sung Lee; Ho Gak Kim
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2009-06-30
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  104     ISSN:  1572-0241     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-06     Completed Date:  2009-10-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2418-21     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, South Korea.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Cholagogues and Choleretics / therapeutic use*
Cholangiopancreatography, Endoscopic Retrograde
Cholelithiasis / radiography,  therapy*
Combined Modality Therapy
Female
Frail Elderly
Humans
Male
Palliative Care / methods
Prospective Studies
Statistics, Nonparametric
Stents*
Terpenes / therapeutic use*
Treatment Outcome
Ursodeoxycholic Acid / therapeutic use*
Chemical
Reg. No./Substance:
0/Cholagogues and Choleretics; 0/Terpenes; 128-13-2/Ursodeoxycholic Acid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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