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Shoji M, Sakuma H, Yoshimitsu Y, et al. Topical nitrate drip infusion using cystic duct tube for retained bile duct stone: A six patients case series. World J Gastrointest Surg. 2013;5(6):210-5doi: 10.4240/wjgs.v5.i6.210.
Shoji, M., Sakuma, H., Yoshimitsu, Y., Maeda, T., Nakai, M., & Ueda, H. (2013). Topical nitrate drip infusion using cystic duct tube for retained bile duct stone: A six patients case series. World journal of gastrointestinal surgery, 5(6), 210-5. https://doi.org/10.4240/wjgs.v5.i6.210
Shoji, Masatoshi, et al. "Topical nitrate drip infusion using cystic duct tube for retained bile duct stone: A six patients case series." World journal of gastrointestinal surgery vol. 5,6 (2013): 210-5. doi: https://doi.org/10.4240/wjgs.v5.i6.210
Shoji M, Sakuma H, Yoshimitsu Y, Maeda T, Nakai M, Ueda H. Topical nitrate drip infusion using cystic duct tube for retained bile duct stone: A six patients case series. World J Gastrointest Surg. 2013 Jun 27;5(6):210-5. doi: 10.4240/wjgs.v5.i6.210. PMID: 23805368; PMCID: PMC3692960.
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World J Gastrointest Surg. 2013 Jun 27;5(6):210-5. doi: 10.4240/wjgs.v5.i6.210.

Topical nitrate drip infusion using cystic duct tube for retained bile duct stone: A six patients case series.

World journal of gastrointestinal surgery

Masatoshi Shoji, Hiroshi Sakuma, Yutaka Yoshimitsu, Tsutomu Maeda, Masuo Nakai, Hiroshi Ueda

Affiliations

  1. Masatoshi Shoji, Hiroshi Sakuma, Yutaka Yoshimitsu, Tsutomu Maeda, Masuo Nakai, Hiroshi Ueda, Department of Surgery, Hoju Memorial Hospital, Nomi, Ishikawa 923-1226, Japan.

PMID: 23805368 PMCID: PMC3692960 DOI: 10.4240/wjgs.v5.i6.210

Abstract

A retained bile duct stone after operation for cholelithiasis still occurs and causes symptoms such as biliary colic and obstructive jaundice. An endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy (EST), followed by stone extraction, are usually an effective treatment for this condition. However, these procedures are associated with severe complications including pancreatitis, bleeding, and duodenal perforation. Nitrates such as glyceryl trinitrate (GTN) and isosorbide dinitrate (ISDN) are known to relax the sphincter of Oddi. In 6 cases in which a retained stone was detected following cholecystectomy, topical nitrate drip infusion via cystic duct tube (C-tube) was carried out. Retained stones of 2-3 mm diameter and no dilated common bile duct in 3 patients were removed by drip infusion of 50 mg GTN or 10 mg ISDN, which was the regular dose of intravenous injection. Three other cases failed, and EST in 2 cases and endoscopic biliary balloon dilatation in 1 case were performed. One patient developed an adverse event of nausea. Severe complications were not observed. We consider the topical nitrate drip infusion via C-tube to be old but safe, easy, and inexpensive procedure for retained bile duct stone following cholecystectomy, inasmuch as removal rate was about 50% in our cases.

Keywords: Cholecystectomy; Cystic duct tube; Nitrate; Retained bile duct stone; Topical drip infusion

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