TITLE:
Effect of Bile Duct Flushing on Reducing the Residue of Common Bile Duct Stones
AUTHORS:
Liang Ye, Yunze Li, Huaiyang Cai
KEYWORDS:
Saline Solution Irrigation, Common Bile Duct Stone, Intraductal Ultrasonography, Endoscopic Retrograde Cholangiopancreatography
JOURNAL NAME:
Open Access Library Journal,
Vol.10 No.4,
April
21,
2023
ABSTRACT: Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure for common bile duct (CBD) stones, because it is known to cause residual stones. Although saline irrigation has been used to reduce residual CBD stones after ERCP, the relevant evidence on the effectiveness of irrigation volume is still unclear. Methods: This prospective trial study was performed at the Department of Gastroenterology, Liuzhou People Hospital affiliated Guangxi Medical University between 2017 and June 2022. Patients with CBD stones were consecutively enrolled at the endoscopy center of our hospital. This study enrolled patients who underwent lithotripsy during ERCP for large CBD stones (>12 mm). Scores (Score 1: a large number of stone segments; Score 2: a small number of stone segments; Score 3: fully removed CBD without any biliary stone fragments) were accurately documented after saline irrigation with 50 mL and 100 mL, and after stone removal, respectively. Results: A total of 112 patients with CBD stones were enrolled. No patient had CBD clearance scores or reached scores of 3 without saline irrigation, 45 (40.2%) patients reached scores of 3 with 50 ml irrigation, and 99 (88.4%) patients reached scores of 3 with 100 ml irrigation. Multivariate analysis indicated that CBD diameter > 15 mm [odds ratio (OR) = 0.93, 95% confidence interval (CI): 0.87 - 0.98, P = 0.013] and angulation of the distal CBD140? (OR = 0.92, 95% CI: 0.83 - 0.98, P = 0.007) were independent risk factors for residual stones. Conclusion: While irrigation with 100 mL saline solution may reduce the recurrence of CBD stones, it cannot flush out all residual CBD stone fragments after mechanical lithotripsy, and additional saline irrigation may be required to clear residual stones.