*Department of Internal Medicine, Inha University Hospital, Incheon, Korea
†Korea Association of Health Promotion, Jeonbuk Branch, Jeonju, Korea
‡National Center of Efficacy Evaluation for the Development of Health Products Targeting Digestive Disorders (NCEED), and Utah-Inha DDS & Advanced Therapeutics Research Center, Incheon, Korea
§Digestive Disease Center and Research Institute, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
||Division of Gastroenterology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
¶Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
#Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University School of Medicine, Cheonan, Korea
**Division of Gastroenterology, Department of Internal Medicine, Korea University Ansan Hospital, Korea University School of Medicine, Ansan, Korea
††Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
‡‡Division of Gastroenterology, Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hwaseong, Korea
Various anatomical features of the biliary tree affect ability to remove difficult common bile duct (CBD) stones. In this study, we evaluated the clinical characteristics and outcomes of the endoscopic treatment of stones in stemware-shaped CBDs.
Thirty-four patients with a stone and a stemware-shaped CBD who were treated at different tertiary referral centers from January 2008 to December 2012 were studied retrospectively. When stone removal failed, percutaneous or direct peroral cholangioscopic lithotripsy, endoscopic retrograde biliary drainage, or surgery was performed as a second-line procedure.
The overall success rate of the first-line procedure was 41.2%. Five of the 34 patients (14.7%) experienced procedure-related complications. No procedure-related mortality occurred. Mechanical lithotripsy was required to completely remove stones in 13 patients (38.2%). Conversion to a second-line procedure was required in 20 patients (58.8%). Mechanical lithotripsy was needed in 75% and 66.7% of those with a stone size of <1 cm or ≥1 cm, respectively. Stone recurrence occurred in two patients (9.1%) after 6 months and 27 months, respectively.
The endoscopic treatment of stones in a stemware-shaped CBD is challenging. The careful assessment of difficult CBD stones is required before endoscopic procedures.