endoprosthesis

The role played by an endoprosthesis is believed to be two-fold.

A similar endoprosthesis is expected to be introduced in Germany in 2009.

The other two patients are awaiting surgery seven and 12 months after endoprosthesis insertion.

In three patients cholangitis occurred from two to seven months after the placement of the endoprosthesis.

This patient had not undergone a sphincterotomy before the insertion of the endoprosthesis.

Management of common bile duct stones with a biliary endoprosthesis.

These three patients were notable for not having undergone a sphincterotomy before the insertion of the endoprosthesis.

The use of a biliary endoprosthesis has been proposed as an alternative approach for patients at high risk for surgery.

Late complications were defined as those occurring after 72 hours after the insertion of the endoprosthesis.

As such, it is termed an endoprosthesis.

In seven cases severe cholangitis was considered a specific indication for the rapid establishment of drainage using an endoprosthesis.

Bile duct drainage was established in all 40 patients (100%) after endoprosthesis insertion.

In the present series we report our experience with biliary endoprosthesis placing for the management of common bile duct stones over a two year period.

Few reports have been published on the use of biliary endoprosthesis for the management of common bile duct stones.

The insertion of an endoprosthesis was successful in establishing adequate biliary drainage in all the patients.

A straight 10 F endoprosthesis was used in the five patients with a bile duct stricture distal to the stones.

Endoscopic placement of a biliary endoprosthesis has been proposed for the management of choledocholithiasis when stone extraction is difficult or considered hazardous.

Reconstruction after surgery can be accomplished with many options including metallic endoprosthesis, allograft, vascularized autologous bone graft, and rotationplasty.

After a period of external biliary drainage (usually 48 hours) the guide wire was reinserted and advanced through the stricture to allow insertion of an endoprosthesis.

In conclusion biliary endoprosthesis insertion for common bile duct stones offers an important alternative means of establishing duct drainage in selected cases.

Bile for cytology was aspirated through a catheter within or above the endoprosthesis by the endoscopist and sent on the day of sampling to the Cytology Department.

First, prompt biliary drainage is established in the obstructed duct and second, subsequent impactation of stones is prevented by the presence of the endoprosthesis within the duct.

At ERCP a mid CBD stricture was visualised at the level of some clips, with concomitant contrast leakage and an endoprosthesis was inserted.

During ERCP a firm stricture, of 3 mm in length, was visualised at the level of several clips and only one 10 Fg endoprosthesis could be inserted initially.

Eight (20%) of the 40 patients underwent surgery, six having a cholecystectomy and exploration of the common bile duct and two a cholecystectomy alone (the endoprosthesis being left in situ ).