Litholyse de contact des calculs de la voie biliaire principale

Etude chez 44 malades

Translated title of the contribution: Contact litholysis of common bile duct stones. Experience in 44 patients

T. Takács, J. Lonovics, François Xavier Caroli-Bosc, Anne Marie Montet, Jean Claude Montet

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives. Endoscopic sphincterotomy has become a generally accepted method for extracting common bile duct stones in high risk or cholecystectomized patients. However, stone extraction is impossible by the usual methods in 5 to 10% of cases. The purpose of this study was to evaluate the effect of a recently developed solvent system in patients with large bile duct stones. Methods. Forty four patients (15 men and 29 women, median age 61 years) underwent contact dissolution after unsuccessful Dormia extraction. Solvents were administered via a nasobiliary catheter in 41 patients following papillotomy and through a T-tube in 3 patients. Solvent mixtures (26 mM ethylene diamine tetraacetic acid, 40 mM sodium deoxycholate and 30% dimethyl sulfoxide in an alkaline aqueous solution; and a 70/30 dimethyl sulfoxide/methyl tert-butyl ether mixture) were infused continuously and alternatively for 2 hours. Results. Bile duct stones disappeared in 13-24 hours of infusion in 11 patients. In 29 patients, a clear reduction in stone volume occurred, allowing complete endoscopic extraction of the fragments. In 4 patients, the size of the stone did not change. Only mild and transient side-effects including abdominal pain (68 %), nausea (72%), vomiting (52%), diarrhea and sleepiness (50%) were observed. Conclusion. Direct dissolution therapy could be an effective method for the non-surgical management of large bile duct stones in selected patients when intra- or extracorporeal lithotripsy is unsuccessful.

Original languageFrench
Pages (from-to)655-659
Number of pages5
JournalGastroenterologie Clinique et Biologique
Volume21
Issue number10
Publication statusPublished - 1997

Fingerprint

Common Bile Duct
Bile Ducts
Dimethyl Sulfoxide
Endoscopic Sphincterotomy
Deoxycholic Acid
Diamines
Lithotripsy
Nausea
Abdominal Pain
Vomiting
Diarrhea
Catheters
Acids

Keywords

  • Common bile duct
  • Contact solvents
  • Endoscopic sphincterotomy
  • Litholysis
  • Stones

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Litholyse de contact des calculs de la voie biliaire principale : Etude chez 44 malades. / Takács, T.; Lonovics, J.; Caroli-Bosc, François Xavier; Montet, Anne Marie; Montet, Jean Claude.

In: Gastroenterologie Clinique et Biologique, Vol. 21, No. 10, 1997, p. 655-659.

Research output: Contribution to journalArticle

Takács, T. ; Lonovics, J. ; Caroli-Bosc, François Xavier ; Montet, Anne Marie ; Montet, Jean Claude. / Litholyse de contact des calculs de la voie biliaire principale : Etude chez 44 malades. In: Gastroenterologie Clinique et Biologique. 1997 ; Vol. 21, No. 10. pp. 655-659.
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abstract = "Objectives. Endoscopic sphincterotomy has become a generally accepted method for extracting common bile duct stones in high risk or cholecystectomized patients. However, stone extraction is impossible by the usual methods in 5 to 10{\%} of cases. The purpose of this study was to evaluate the effect of a recently developed solvent system in patients with large bile duct stones. Methods. Forty four patients (15 men and 29 women, median age 61 years) underwent contact dissolution after unsuccessful Dormia extraction. Solvents were administered via a nasobiliary catheter in 41 patients following papillotomy and through a T-tube in 3 patients. Solvent mixtures (26 mM ethylene diamine tetraacetic acid, 40 mM sodium deoxycholate and 30{\%} dimethyl sulfoxide in an alkaline aqueous solution; and a 70/30 dimethyl sulfoxide/methyl tert-butyl ether mixture) were infused continuously and alternatively for 2 hours. Results. Bile duct stones disappeared in 13-24 hours of infusion in 11 patients. In 29 patients, a clear reduction in stone volume occurred, allowing complete endoscopic extraction of the fragments. In 4 patients, the size of the stone did not change. Only mild and transient side-effects including abdominal pain (68 {\%}), nausea (72{\%}), vomiting (52{\%}), diarrhea and sleepiness (50{\%}) were observed. Conclusion. Direct dissolution therapy could be an effective method for the non-surgical management of large bile duct stones in selected patients when intra- or extracorporeal lithotripsy is unsuccessful.",
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