Palliative treatment of large bile duct stones by endoscopic implantation of endoprosthesis in high risk patients

UNLABELLED: Endoscopic insertion of biliary stents is an established method in the palliative treatment of malignant bile duct stenoses. However, there is less experience concerning the long term effect of endoprostheses in patients with large bile duct stones. PATIENTS AND METHOD: Straight polyethylen endoprostheses of 12 Fr diameter were transpapillary placed because of large bile duct stones in 25 patients during a 5-year-period. The stents were inserted for transitoric decompression and for permanent treatment in 2 and 23 cases, respectively. Unsuccessful endoscopic stone removal (inc. mechanical lithotripsy) in high risk patients or extremely limited tolerability of patients during the endoscopic procedure were regarded as indications of stenting. The patients were followed clinically, biochemically and endoscopically for a period of 6 months to 5 years (mean 22.7 months). RESULTS: No early complication was observed. Late cholangitis occurred in three patients due to endoprosthesis dislodging and clogging in two cases and one, resp. All complications were successfully managed by endoscopic route. In further three patients elective stent exchange was performed. 8 patients died during the follow-up period, the cause of death was independent of gallstone disease in all cases. Without any stent exchange, 13 patients are symptom-free for 6-60 months. CONCLUSIONS: Endoscopic endoprothesis placement is a simple, cost-effective, relatively safe and well tolerable method for transitoric biliary decompression and for long term treatment in high risk patients with endoscopically not removable large bile duct stones. In contrast with malignant stenoses, in cases of bile duct stones elective exchange of the stent is not necessary, only clinical and biochemical follow-up suggested.