Saline irrigation of the bile duct prevents residual stones
Preventive saline irrigation of the bile duct (PSIB) appears to be effective in reducing residual stones after endoscopic common bile duct stone (CBD) removal, according to a recent study.
Researchers randomized 148 patients who underwent endoscopic retrograde cholangiopancreatography to either receive (n=73) or not receive (n=75) PSIB after stone removal. Presence of residual stones was evaluated within 6 months after the operation.
Residual stones were reported in 14.9 percent (n=22), five of whom received PSIB (6.8 percent) while 17 did not (22.7 percent). The difference in residual stone incidence rate reached statistical significance (p=0.01).
Multivariate logistic regression analysis revealed that PSIB had a significant protective effect against residual stones following CBD removal (odds ratio [OR], 0.09; 95 percent CI, 0.02–0.45; p=0.003). In contrast, the presence of multiple CBD stones significantly increased the risk of residual stones (OR, 9.40; 1.86–47.54; p=0.007).
A subsequent subgroup analysis showed that PSIB had greater efficacy against residual stones in patients with multiple CBD stones (rate of residual stones, 12.1 percent in PSIB group vs 50.0 percent in non-PSIB group).
The rate of procedure-related complications was 12.8 percent (n=19), the most common of which was pancreatitis. There was no significant difference in the number of patients who experienced complications in the PSIB vs non-PSIB groups (p=0.793). The rate of cholangitis was slightly higher in the PSIB group (5.5 percent vs 2.7 percent), and all patients were given conservative management.