Endoscopic removal of common bile duct (CBD) stones after
endoscopic sphincterotomy (EST) is now a widely accepted procedure. Surgery is usually recommended when extraction of stones after EST fails. For patients with major medical problems or who are at high surgical risk, however, endoscopic
stent placement may help to prevent stone impaction and
cholangitis. In this report, we describe the long-term effects and complications of biliary
stent use in elderly patients with CBD stones. From August 1995 to June 1998, 19 patients with CBD stones underwent
stent placement by duodenoscopy. Three of these patients underwent this procedure for temporary treatment while awaiting surgery or EST. In the remaining 16 patients (6 men and 10 women, mean age 76 +/- 10 years), invasive management carried a high risk of complications. We used a 7F straight
stent for the first patient, while the remaining 15 received 7F pigtail
stents. During a mean follow-up period of 34 months, two patients were lost to follow-up and two patients had migration of the
stents. Three patients had acute
cholangitis with
stents in situ. Of these, one underwent
stent exchange 8 months later, while the CBD stones were cleared either by endoscopy or surgery in the other two patients. Five patients died of nonbiliary diseases during the follow-up period. Our results show that long-term biliary
stent placement is an advisable alternative therapeutic modality for high-risk and debilitated patients with CBD stones.