Stones Solutions of Biliary Duct Tree

 Stones Solutions of Biliary Duct Tree

---key words: ERCP, EST, LC

Suitable time interval of ERCP +EST and LC

LC (laparoscopic cholecystectomy) is presently the first choice of gallbladder stones treatment.

In the realistic statistics, 10% patients in gall bladder stones are companied with stones at common bile duct. For these groups of patients, if applied with open surgery, cutting of common bile duct for stone retrieval and T shape tube drainage shall lead to dramatic trauma on the patients with long time in hospital.Open surgery also has risks for old-age patients with other organ diseases. However, LC operation technique and technology does not have mature technology to probe into the common bile duct.

In this circumstance, ERCP + EST combined with LC are effective and safe choices of the patients suspected with common bile duct stones and gall bladder stones.

One of the most controversial discussion lies on the sequence of ERCP and LC. In most clinical cases, ERCP and EST are applied before the LC operation. Another question is about the suitable time interval to make LC after ERCP and EST.

(With reference of ERCP+EST combined with LC in treating stone in common bile duct and gall bladder, choices of operational time and treatment effect from Clinical Medical Engineering).

With the purpose of detecting the suitable time interval of ERCP, EST and LC, the affiliated hospital Hongqi Hospital of Mudan River did the research in 53 patients received with bile duct stone and separated them into Test Group and Contrast Group. The test group patients received LC one day after ERCP and EST, while the contrast group patients received LC three days after ERCP and EST. Compare the data after the operation.

The result shows that the hospital stay time of test group is apparently shorter than the contrast group. The after operational ALT, AST, AMY, and the rate of transferring to open surgery do not show obvious difference.

Presently, LC operation is normally performed 3 days after ERCP+ EST. According to the result of this research, longer time interval after operation may take the patients stay in hospital longer and increase the medical cost. This also increases the rate of gall bladder stones falling into the common bile duct.

In the case of rising serum amylase, which is the indicator of pancreatitis, perform LC at the shortest interval is also a good choice, without bringing more risks of pancreatitis.  

Necessity of ERCP diagnosis before and afterLC in treatment of biliary duct system trees

Laparoscopic cholecystectomy (LC) is an operation with two –dimension vision. ERCP diagnosis before LC could identify the stone location, quantity and size clearly. It could also detect the bile duct eclasis and tumor. A comprehensive understanding of bile duct biliary tree system statusbeforeoperationis essential for the physicians to choose operational type and procedures. The biopsy could be taken during ERCP for pathological examination.

Another advantage of ERCP before LC is to prevent the occurrence of operational injury, such as transection, stenosis and fistula of bile duct. To evaluate the shape of extra hepatic bile duct could prevent the possible injury in the operation.

If operation injury occurs, most cases could be treated endoscopically by ERCP. For example, the regional stenosis could be treated by dilation or stent. Fistula shall be treated by nasal drainage tube. Once the biliary injury is suspected, ERCP treatment should be applied as early as possible.

Indications of ERCP before LC (reference from ZHEJIANG Medical edition: Vol.25, No.1, 2003)

1. Previous or present jaundice

2. History of biliary pancreatitis

3. Bile duct diameter larger than 9mm under image inspection but no stone detected on bile duct.

4. Stone detected in common bile duct, and the possibility of hepatic bile duct stone could be excluded.