December07, Unitedkingdom  2021 

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Abstract Volume: 3 Issue: 4 ISSN:

Endoscopic Removal of Longest CBD Stone

Dr Abdul Manan Khaskheli1
 

1, MBBS, MCPS, MRCP, FCPS, Clinical Assistant Professor and Associate Staff Physician Gastroenterology.


Corresponding Author: Dr. Abdul Manan Khaskheli, MBBS, MCPS, MRCP, FCPS, Clinical Assistant Professor and Associate Staff Physician Gastroenterology.


Copy Right: © 2021 Dr. Abdul Manan Khaskheli. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.         


Received Date: September 08, 2021

Published date: October 01, 2021

Endoscopic Removal of Longest CBD Stone

Case

A 19 years old lady with no Known Co morbidities was referred us with History of right hypochondrial pain without fever, jaundice or itching, her other systemic review was unremarkable. Base line blood test including full blood count, Liver function test and coagulation were normal. Ultrasound of abdomen showed multiple gall stones and a stone in CBD.

Base on the findings of imaging an ERCP (Endoscopic retrograde Cholangiopancreatography) was performed after explaining the risk and benefit of the procedure, a written consent taken. ERCP was performed under controlled sedation. Cholangiogram showed large filling defect occupying most of the CBD length consistent with stone (Fig:1),Widest calibrated CBD diameter was 17mm. A large Sphincterotomy performed, balloon passed through guidewire and a Large elongated stone of 6cm long and 1.1cm wide was retrieved (Fig:2)

Patient was kept under observation, no immediate complication seen and patient was referred for Cholecystectomy Considering the large size of stone and its hard consistency stone retrieved from the gut with the help of snare as shown in Fig:3


Discussion

Gall stone disease and its complication is one of the common problems in this part of world, probably because of the increase number of patients with haemoglobinopathies apart from other risk factor. Also, the size of CBD (common bile duct) stone may vary in this region compared to west, large, multiple and impacted stone are seen commonly here.  Endoscopic retrograde cholangiography (ERC) with endoscopic sphincterotomy (ES) and stone extraction has been increasingly used as primary management strategy for Cholidocholithiasis for the past few decades and are considered standard therapies for the treatment of common bile duct (CBD) stones1-3.

In majority of cases the clearance of duct can be achieved by this conventional method and Reported success rate is ranging from 85% to 100% in different studies4-5. But ERC become more challenging for endoscopist when stones are larger (>15mm), stones above the stricture or impacted stones6.

Definition of large CBD stone is still not clear but stone more then >10—15 mm in diameter is considered as large stone.

There are multiple other therapeutic techniques available when the traditional techniques are failed to remove the stone. Mechanical lithotripsy or shock wave lithotripsy are usually considered as safe and effective alternate methods of retrieving stones6-8

In our limited experience at our institution so far we did more then 250 ERCPs and majority cases had CBD stones, this is the longest CBD stone which was removed endoscopically, it is unique in a sense that the stone was of CBD shaped(elongated) it is longest stone so far which is removed by conventional technique (ERCP with ES) and retrieval Balloon without using ESWL or EPBD(Endoscopic papillary balloon dilatation.


References

1. Williams EJ, Green J, Beckingham I, Parks R, Martin D, Lombard M. “Guidelines on the management of common bile duct stones (CBDS)”. Gut. 2008; 57:1004-1021.

2. Maple JT, Ben-Menachem T, Anderson MA, Appalaneni V, Banerjee S, Cash BD, Fisher L, Harrison ME, Fanelli RD, Fukami N. “The role of endoscopy in the evaluation of suspected choledocholithiasis”. Gastrointest Endosc. 2010;71:1-9.

3. Kawai K, Akasaka Y, Murakami K, Tada M, Koli Y. “Endoscopic sphincterotomy of the ampulla of Vater”. Gastrointest Endosc. 1974; 20:148-151.

4. Cotton PB. “Non-operative removal of bile duct stones by duodenoscopic sphincterotomy”. Br J Surg. 1980; 67:1-5.

5. Yoo KS, Lehman GA. “Endoscopic management of biliary ductal stones”. Gastroenterol Clin North Am. 2010;39:209-227.

6. Binmoeller KF, Schafer TW. “Endoscopic management of bile duct stones”. J Clin Gastroenterol. 2001;32:106-118.

7. Adler DG, Conway JD, Farraye FA, Kantsevoy SV, Kaul V, Kethu SR, Kwon RS, Mamula P, Pedrosa MC, Rodriguez SA. “Biliary and pancreatic stone extraction devices”. Gastrointest Endosc. 2009;70:603-609.

8. Muratori R, Azzaroli F, Buonfiglioli F, Alessandrelli F, Cecinato P, Mazzella G, Roda E. “ESWL for difficult bile duct stones: a 15-year single centre experience”. World J Gastroenterol. 2010; 16:4159-4163.

Figure 1

Figure 2

Figure 3