Abstract
A 84-year-old man was admitted to our hospital in December 1993 for the purpose of further examination of recurrent cholangitis. He had undergone Billroth II gastrectomy for gastric cancer at the age of 65 and pancreaticoduodenectomy in January 1993 for pancreatic head cancer. Endoscopic retrograde cholangiography showed a stricture at the bilioentelic anastomosis and a multiple bile duct stones. Thus, it was thought to he difficult to extract stares in a single session, and we performed balloon dilation of the anastomatic stricture, placed 7Fr, double pig-tail stmt in the bile duct for the purpose of preventing from impaction of the stone and maintaining patency of the duct. After 8 months, August 1894, he developed cholangitis due to stent occlusion. The cholangiography showed little change with the stones and the occluded scent was exchanged. Thereafter, the per oral administration of ursodeoxycholic acid (UDCA) was added to the biliary endoprosthesis. Six months later, he developed cholangitis again and we exchanged the stent. Cholangiography at that tirne showed a marked decrease in the stone number and size, only one stone was remained. Finally, 12 months later, September 1995, we found the migrated tent from the bile duct, the dilated anastomosis and disappearance of the stone. Since then, we have been treated with only UDCA and he has been in good condition. The combination therapy of endoscopic biliary drainage and UDCA was easily and considered to be effective for elder or poor risk patients with nonextractable common bile duct stones.
