Document Detail


Is the addition of choleretic agents in multiple double-pigtail biliary stents effective for difficult common bile duct stones in elderly patients? A prospective, multicenter study.
MedLine Citation:
PMID:  21531412     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Temporary biliary stenting is both technically easy and feasible, and choleretic agents such as ursodeoxycholic acid (UDCA) and a terpene preparation may promote a reduction in stone size. However, there are few comparative data on the effectiveness of choleretic agents available.
OBJECTIVE: To investigate the efficacy of multiple double-pigtail stents with or without UDCA and terpene on difficult common bile duct (CBD) stones.
DESIGN: A prospective, multicenter study.
SETTING: Four tertiary-care referral centers.
PATIENTS: This study involved 51 patients.
INTERVENTION: In total, 51 elderly patients with comorbidities who had difficult CBD stones refractory to conventional methods were randomized to receive either multiple 7F double-pigtail stents (group A) or stents in combination with UDCA and terpene (group B) for a period of 6 months.
MAIN OUTCOME MEASUREMENTS: Stone size reduction, successful duct clearance, and complications.
RESULTS: Complete endoscopic duct clearance was achieved in 14 patients (73.7%) in group A and 19 patients (86.4%) in group B (P = .826). The mean size of CBD stones (transverse/longitudinal diameter, mean ± SD) was 19.12 ± 4.48 mm/20.47 ± 3.86 mm in group A and 21.30 ± 7.08 mm/22.58 ± 7.61 mm in group B. Stone size decreased significantly to 12.04 ± 3.26 mm/13.31 ± 5.12 mm and 13.67 ± 5.40 mm/14.04 ± 6.12 mm, respectively (P < .01). However, there was no statistical difference in stone size reduction between the two groups (P = .685, P = .289). No serious complications related to the stent or endoscopic procedures were observed, except for cholangitis (n = 1, group A) and distal stent migration (n = 2, group B).
LIMITATIONS: Small number of patients in East Asia.
CONCLUSION: Temporary multiple double-pigtail biliary stenting was a safe and feasible method of treating difficult and large CBD stones in elderly patients and contributed to a reduction in stone size and successful duct clearance. However, the addition of choleretic agents did not result in a statistical difference in stone size or rate of successful duct clearance.
Authors:
Tae Hoon Lee; Joung-Ho Han; Hong Ja Kim; Seon Mee Park; Sang-Heum Park; Sun-Joo Kim
Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial     Date:  2011-04-30
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  74     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-06-27     Completed Date:  2011-12-07     Revised Date:  2012-04-26    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  96-102     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Cheonan, Republic of Korea. thlee9@lycos.co.kr
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Cholagogues and Choleretics / administration & dosage*
Cholangiopancreatography, Endoscopic Retrograde
Choledocholithiasis / drug therapy*,  therapy
Drug Combinations
Female
Gallstones / drug therapy*,  therapy
Humans
Male
Middle Aged
Monoterpenes / administration & dosage
Prospective Studies
Prosthesis Implantation
Stents*
Ursodeoxycholic Acid / administration & dosage
Chemical
Reg. No./Substance:
0/Cholagogues and Choleretics; 0/Drug Combinations; 0/Monoterpenes; 128-13-2/Ursodeoxycholic Acid; 65546-74-9/Rowachol
Comments/Corrections
Comment In:
Endoscopy. 2012 Apr;44(4):383-8   [PMID:  22438148 ]

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


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