Advertisement

Surgical Endoscopy

, Volume 32, Issue 2, pp 1077–1081 | Cite as

Self-expandable metal stents for the extraction of common bile duct stones in patients receiving dual antiplatelet agents: a pilot study

  • Eunae Cho
  • Chang Hwan ParkEmail author
  • Chung Hwan Jun
  • Hyun Soo Kim
  • Sung Kyu Choi
  • Jong Sun Rew
New Technology

Abstract

Background

Endoscopic sphincterotomy or endoscopic papillary balloon dilatation during endoscopic retrograde cholangiopancreatography (ERCP) are associated with a high risk of bleeding in patients receiving dual antiplatelet agents (APAs). However, the discontinuation of antiplatelet agents increases the risk of thromboembolic events in these patients. To date, the placement of self-expandable metal stents (SEMSs) in patients receiving dual APAs has not been well investigated. The aim of this study was to evaluate the feasibility and safety of SEMS placement for the removal of common bile duct (CBD) stones in patients in whom APAs were not discontinued.

Methods

Ten consecutive patients who were suspected of having CBD stones and who were receiving dual APAs were prospectively enrolled and underwent temporary SEMS placement, followed by stone extraction and SEMS removal. The patients continued taking dual APAs at the time of undergoing the procedure.

Results

SEMS placement was successful in all ten patients. Complete duct clearance with the SEMSs was achieved in a single session in all patients with CBD stones (9/9, 100%). One patient had cholangitis, but ERCP did not reveal biliary stones. There were no cases of bleeding during or after the procedure, even though all patients continued to take dual APAs. There were no new thromboembolic events.

Conclusions

SEMSs can be used for the extraction of CBD stones in patients on dual APAs, and does not lead to hemorrhagic or thromboembolic events.

Keywords

Choledocholithiasis ERCP Self-expandable metal stent (SEMS) Antiplatelet agents 

Notes

Compliance with ethical standards

Disclosure

Drs. Eunae Cho, Chang Hwan Park, Chung Hwan Jun, Hyun Soo Kim, Sung Kyu Choi, and Jong Sun Rew have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Itoi T, Wang HP (2010) Endoscopic management of bile duct stones. Dig Endosc 22(Suppl 1):S69–S75CrossRefPubMedGoogle Scholar
  2. 2.
    Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, Moore JP, Fennerty MB, Ryan ME, Shaw MJ, Lande JD, Pheley AM (1996) Complications of endoscopic biliary sphincterotomy. N Engl J Med 335:909–918CrossRefPubMedGoogle Scholar
  3. 3.
    Park SJ, Kim JH, Hwang JC, Kim HG, Lee DH, Jeong S, Cha SW, Cho YD, Kim HJ, Moon JH, Park SH, Itoi T, Isayama H, Kogure H, Lee SJ, Jung KT, Lee HS, Baron TH, Lee DK (2013) Factors predictive of adverse events following endoscopic papillary large balloon dilation: results from a multicenter series. Dig Dis Sci 58:1100–1109CrossRefPubMedGoogle Scholar
  4. 4.
    Zhao HC, He L, Zhou DC, Geng XP, Pan FM (2013) Meta-analysis comparison of endoscopic papillary balloon dilatation and endoscopic sphincteropapillotomy. World J Gastroenterol 19:3883–3891CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Steinhubl SR, Berger PB, Mann JT 3rd, Fry ET, DeLago A, Wilmer C, Topol EJ (2002) Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA 288:2411–2420CrossRefPubMedGoogle Scholar
  6. 6.
    Sabouret P, Rushton-Smith SK, Kerneis M, Silvain J, Collet JP, Montalescot G (2015) Dual antiplatelet therapy: optimal timing, management, and duration. Eur Heart J Cardiovasc Pharmacother 1:198–204CrossRefPubMedGoogle Scholar
  7. 7.
    Veitch AM, Vanbiervliet G, Gershlick AH, Boustiere C, Baglin TP, Smith LA, Radaelli F, Knight E, Gralnek IM, Hassan C, Dumonceau JM (2016) Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Gut 65:374–389CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Kahaleh M, Behm B, Clarke BW, Brock A, Shami VM, De La Rue SA, Sundaram V, Tokar J, Adams RB, Yeaton P (2008) Temporary placement of covered self-expandable metal stents in benign biliary strictures: a new paradigm? (with video). Gastrointest Endosc 67:446–454CrossRefPubMedGoogle Scholar
  9. 9.
    Cerefice M, Sauer B, Javaid M, Smith LA, Gosain S, Argo CK, Kahaleh M (2011) Complex biliary stones: treatment with removable self-expandable metal stents: a new approach (with videos). Gastrointest Endosc 74:520–526CrossRefPubMedGoogle Scholar
  10. 10.
    Kwok A, Faigel DO (2009) Management of anticoagulation before and after gastrointestinal endoscopy. Am J Gastroenterol 104:3085–3097 (Quiz 3098) CrossRefPubMedGoogle Scholar
  11. 11.
    Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, Liguory C, Nickl N (1991) Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 37:383–393CrossRefPubMedGoogle Scholar
  12. 12.
    Minami A, Fujita R (2003) A new technique for removal of bile duct stones with an expandable metallic stent. Gastrointest Endosc 57:945–948CrossRefPubMedGoogle Scholar
  13. 13.
    Maxton DG, Tweedle DE, Martin DF (1995) Retained common bile duct stones after endoscopic sphincterotomy: temporary and longterm treatment with biliary stenting. Gut 36:446–449CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Yasuda I, Tomita E, Enya M, Kato T, Moriwaki H (2001) Can endoscopic papillary balloon dilation really preserve sphincter of Oddi function? Gut 49:686–691CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Jun CH, Park CH, Jeon J, Park IH, Lee HJ, Park SY, Kim HS, Choi SK, Rew JS (2015) Feasibility of self-expandable metal stents for preservation of sphincter of Oddi function in patients with common bile duct stones: a pilot study. Gastrointest Endosc 82:719–723CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Eunae Cho
    • 1
  • Chang Hwan Park
    • 1
    Email author
  • Chung Hwan Jun
    • 1
  • Hyun Soo Kim
    • 1
  • Sung Kyu Choi
    • 1
  • Jong Sun Rew
    • 1
  1. 1.Division of Gastroenterology, Department of Internal MedicineChonnam National University Medical SchoolGwangjuSouth Korea

Personalised recommendations