Gut Liver.  2015 Nov;9(6):800-804. 10.5009/gnl14433.

Clinical Features and Outcomes of Endoscopic Treatment for Stones in Stemware-Shaped Common Bile Ducts: A Multicenter Data Analysis

  • 1Department of Internal Medicine, Inha University Hospital, Incheon, Korea.
  • 2Korea Association of Health Promotion, Jeonbuk Branch, Jeonju, Korea.
  • 3National Center of Efficacy Evaluation for the Development of Health Products Targeting Digestive Disorders (NCEED), and Utah-Inha DDS & Advanced Therapeutics Research Center, Incheon, Korea.
  • 4Digestive Disease Center and Research Institute, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
  • 5Division of Gastroenterology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.
  • 6Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
  • 7Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University School of Medicine, Cheonan, Korea.
  • 8Division of Gastroenterology, Department of Internal Medicine, Korea University Ansan Hospital, Korea University School of Medicine, Ansan, Korea.
  • 9Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea.
  • 10Division of Gastroenterology, Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hwaseong, Korea.


Various anatomical features of the biliary tree affect ability to remove difficult common bile duct (CBD) stones. In this study, we evaluated the clinical characteristics and outcomes of the endoscopic treatment of stones in stemware-shaped CBDs.
Thirty-four patients with a stone and a stemware-shaped CBD who were treated at different tertiary referral centers from January 2008 to December 2012 were studied retrospectively. When stone removal failed, percutaneous or direct peroral cholangioscopic lithotripsy, endoscopic retrograde biliary drainage, or surgery was performed as a second-line procedure.
The overall success rate of the first-line procedure was 41.2%. Five of the 34 patients (14.7%) experienced procedure-related complications. No procedure-related mortality occurred. Mechanical lithotripsy was required to completely remove stones in 13 patients (38.2%). Conversion to a second-line procedure was required in 20 patients (58.8%). Mechanical lithotripsy was needed in 75% and 66.7% of those with a stone size of <1 cm or > or =1 cm, respectively. Stone recurrence occurred in two patients (9.1%) after 6 months and 27 months, respectively.
The endoscopic treatment of stones in a stemware-shaped CBD is challenging. The careful assessment of difficult CBD stones is required before endoscopic procedures.


Common bile duct; Choledocholithiasis; Mechanical lithotripsy; Cholangiopancreatography, endoscopic retrograde
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