Non-invasive treatment for retained common bile duct stones in patients with T tube in situ: Saline washout after intravenous ceruletide

Abstract

The combination of ceruletide‐induced relaxation of the sphincter of Oddi plus flushing with saline has recently been proposed as a novel procedure for the treatment of residual common bile duct (CBD) stones. In this study we have administered intravenous ceruletide (2 ng kg⁻¹ body weight min⁻¹ for 1 h) plus intraductal saline (800–3000 ml, infused at a rate that kept biliary pressure below 30 cmH₂O) to a group of 14 patients. The treatment induced the passage of residual stones in 11 subjects (79 per cent) with complete clearance in 7 (50 per cent). The majority of the cleared concretions (11/15) had a diameter < 10 mm. No severe side‐effects were recorded during the treatment. Four of the seven subjects who exhibited incomplete CBD clearance underwent a short cycle of mono‐octanoin administration in order to reduce the size of residual radiolucent stones. This course of treatment was followed by another attempt with intravenous ceruletide and saline washout which gave a successful response in an additional three cases. These data indicate that the combination of ceruletide and flushing is a safe and inexpensive method for treatment of residual stones. The procedure is feasible for both radiolucent and radio‐opaque stones and is mainly eligible for small concretions of diameter 10 mm) radiolucent stones may be partially dissolved with mono‐octanoin and then eliminated by the washout technique.