Could saline irrigation clear all residual common bile duct stones after lithotripsy? A self-controlled prospective cohort study.

Content Provider	Europe PMC
Author	Lin, Yan-Yan Wang, Yu-Dong Yue, Ping Zhang, Xian-Zhuo Leung, Joseph W Jiao, Pan-Pan Yang, Man Wang, Hai-Ping Bai, Bing Liu, Ying Zhang, Jin-Duo Chen, Hong-Bo Meng, Wen-Bo Li, Xun
Copyright Year	2021
Abstract	BACKGROUNDA previous study showed that irrigation with 100 mL saline reduced residual common bile duct (CBD) stones, which potentially cause recurrent stones after endoscopic retrograde cholangiopancreatography.AIMTo determine whether saline irrigation can improve CBD clearance after lithotripsy.METHODSThis prospective self-controlled study enrolled patients receiving mechanical lithotripsy for large (> 1.2 cm) CBD stones. After occlusion cholangiography confirmed CBD stone clearance, peroral cholangioscopy (POC) was performed to determine clearance scores based on the number of residual stones. The amounts of residual stones spotted via POC were graded on a 5-point scale (score 1, worst; score 5, best). Scores were documented after only stone removal (control) and after irrigation with 50 mL and 100 mL saline, respectively. The stone composition was analyzed using infrared spectroscopy.RESULTSBetween October 2018 and January 2020, 47 patients had CBD clearance scores of 2.4 ± 1.1 without saline irrigation, 3.5 ± 0.7 with 50 mL irrigation, and 4.6 ± 0.6 with 100 mL irrigation (P < 0.001). Multivariate analysis showed that CBD diameter > 15 mm [odds ratio (OR) = 0.08, 95% confidence interval (CI): 0.01-0.49; P = 0.007] and periampullary diverticula (PAD) (OR = 6.51, 95%CI: 1.08-39.21; P = 0.041) were independent risk factors for residual stones. Bilirubin pigment stones constituted the main residual stones found in patients with PAD (P = 0.004).CONCLUSIONIrrigation with 100 mL of saline may not clear all residual CBD stones after lithotripsy, especially in patients with PAD and/or a dilated (> 15 mm) CBD. Pigment residual stones are soft and commonly found in patients with PAD. Additional saline irrigation may be required to remove retained stones.
ISSN	10079327
Volume Number	27
PubMed Central reference number	PMC7852583
Issue Number	4
PubMed reference number	33584068
Journal	World Journal of Gastroenterology [World J. Gastroenterol]
e-ISSN	22192840
DOI	10.3748/wjg.v27.i4.358
Language	English
Publisher	Baishideng Publishing Group Inc
Publisher Date	2021-01-01
Access Restriction	Open
Rights License	This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Subject Keyword	Endoscopic retrograde cholangiopancreatography Common bile duct gall stones Peroral cholangioscopy Saline irrigation Periampullary diverticula Prospective cohort study
Content Type	Text
Resource Type	Article
Subject	Gastroenterology