Views:4 Author:Site Editor Publish Time: 2019-06-11 Origin:Site
Plastic Stent in Treatment of Refractory Biliary Stricture
Stone retrieval basket and balloon extraction catheter have generally high successful rate in treating biliary stone diseases. However, for refractory biliary stricture, stone retrieval at one time has large difficulty accompanied with high risks.
Refractory biliary stricture and biliary stone are mainly caused by two kinds of reasons: one kind is due to the patients’ anatomy and stones situation. In this way, stone retrieval has high technical difficulties: such as multi diverticulum around ampulla, large diverticulum besides papilla, papilla wrapped by diverticulum, papilla of small size, distal strictures on biliary duct with stones, postoperative patients with stomach and jejunum anastomosis, stone diameter more than 20 mm, multiple stones or full stones, ampulla stone embedment, etc.
In the other case, patients cannot tolerate long-term endoscopic operations due to poor physical conditions, such as old age, cardiopulmonary diseases and diabetes.
Other methods are often adopted for refractory common bile duct stone retrieval treatment, like mechanical lithotripsy, laser lithotripsy and extracorporeal shock wave lithotripsy.For mechanical lithotripsy treatment, retrieval basket is required to catch the stones. While in the cases of full stones, large stones, and stone embedment, basket cannot go over the stones or cannot be opened to catch the stones. In this way, mechanical lithotripsy cannot succeed in stone retrieval.
Before extracorporeal shock wave lithotripsy, nasal biliary drainage tube is usually placedby ERCP; afterlithotripsy, nasal drainage tube should be removed again through endoscope. The operation process is complicated and time consuming. Therefore this method is still not the first choice.
For those patients with refractory common bile duct stone, especially combined with infections in bile duct. Timely biliary drainage is one of the most important measures to save patients and to bring opportunity for subsequent treatment.
Here are the general tips for plastic biliary stent usage in the treatment of refractory biliary stricture and stones.
Conventional ERCP operation was performed, and appropriate plastic biliary stent was selected for drainage according to the conditions of gallstones and common bile duct.
The placement of the plastic stent should be selected in the dilated bile duct above the stone.
In order to facilitate the placement of the stent, the stenosis of the bile duct can be dilated first, and then it can be expanded step by step according to the size of the endoscope and the stent.
Determine the diameter of the applicator. The principle is that the larger the diameter, the better the drainage effect.
The sphincterotomy should be done routinely before the biliary duct plastic stent is placed.
Plastic stent placement can prevent postoperative complications of pancreatitis.
After the plastic stent is placed, the drainage effect of the stent is mainly observed, and the endoscope can be withdrawn after confirming that the drainage is satisfactory.
MMJC, Feb 2018, Vol 20, No.2