Treatment options for large common bile duct stones

Abstract

This is a retrospective analysis of the medical records of patients diagnosed to have large common bile duct stones (> 15 mm). The study was designed to evaluate different modalities of large bile duct stone treatment. The setting is King Khalid University Hospital, Gastroenterology Unit. The medical records of patients (n=64) diagnosed to have large common bile duct stones by endoscopic retrograde cholangiography over a period of nine years were included. Files were reviewed and information obtained which included patients' age, sex, nationality, presenting symptoms, number and size of bile duct stones, presence of ascending cholangitis, mode of treatment received, complications and outcome. There were a total of 64 patients; 28 males and 36 females, with a mean age of 61 + 16.6 years. Successful stone extraction was achieved in 44 (69%) patients while surgical treatment was required in 20 patients. Surgically managed patients had significantly larger stones (P<0.003) and were more frequently jaundiced (P<0.014). There was 7.8% of the total number of patients who developed complications that were managed conservatively with full recovery. It was concluded that large stones are difficult to extract endoscopically and more frequently require additional treatment.