Retrospective Study
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World J Gastroenterol. Aug 7, 2014; 20(29): 10121-10127
Published online Aug 7, 2014. doi: 10.3748/wjg.v20.i29.10121
Using cholecystokinin to facilitate endoscopic clearance of large common bile duct stones
Tao Tao, Qi-Jie Zhang, Ming Zhang, Xiao Zhu, Shu-Xia Sun, Yan-Qing Li
Tao Tao, Yan-Qing Li, Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
Tao Tao, Qi-Jie Zhang, Department of Gastroenterology, Zi Bo Central Hospital, Zibo 255000, Shandong Province, China
Ming Zhang, Department of Rehabilitation, Zi Bo Central Hospital, Zibo 255000, Shandong Province, China
Xiao Zhu, Guangdong Province Key Laboratory of Medical Molecular Diagnosis, Guangdong Medical College, Dongguan 523808, Guangdong Province, China
Shu-Xia Sun, Department of Gynecology, Zi Bo Central Hospital, Zibo 255000, Shandong Province, China
Author contributions: Tao T performed the majority of experiments and wrote the manuscript; Zhang QJ, Zhang M, Zhu X and Sun SX provided analytical tools and were also involved in editing the manuscript; Zhang QJ coordinated and provided the collection of experimental data; Li YQ designed the study in addition to providing financial support for this work.
Correspondence to: Yan-Qing Li, PhD, Department of Gastroenterology, Qilu Hospital of Shandong University, No.107, Wenhuaxi Road, Jinan 250012, Shandong Province, China. liyanqing@sdu.edu.cn
Telephone: +86-531-82169022 Fax: +86-531-82169022
Received: October 31, 2013
Revised: April 18, 2014
Accepted: April 27, 2014
Published online: August 7, 2014
Abstract

AIM: To evaluate the effect of cholecystokinin (CCK) during extracorporeal shockwave lithotripsy (ESWL) in the clearance of common bile duct (CBD) stones in endoscopic retrograde cholangiopancreatography (ERCP).

METHODS: Between January 2007 and September 2012, patients with large CBD stones who were treated with ESWL and ERCP were identified retrospectively. Patients were randomized in equal numbers to cholecystokinin (CCK) and no CCK groups. For each CCK case, a dose (3 ng/kg per min for 10 min) of sulfated octapeptide of CCK-8 was administered intravenously near the beginning of ESWL. ERCP was performed 4 h after a session of ESWL. The clearance rate of the CBD was assessed between the two groups.

RESULTS: A total of 148 consecutive cases (CCK group: 74, no CCK group: 74) were tallied. Overall there were 234 ESWLs and 228 ERCPs in the 148 cases. The use of CCK showed a significantly higher rate of successful stone removal in the first ESWL/ERCP procedure (71.6% vs 55.4%, P = 0.035), but resulted in similar outcomes in the second (42.8% vs 39.4%) and third (41.7% vs 40.0%) sessions, as well as total stone clearance (90.5% vs 83.8%). The use of mechanical lithotripsy was reduced in the CCK group (6.8% vs 17.6%, P = 0.023), and extremely large stone (≥ 30 mm) removal was higher in the CCK group (72.7% vs 41.7%, P = 0.038).

CONCLUSION: CCK during ESWL can aid with the clearance of CBD stones in the first ESWL/ERCP session. Mechanical lithotripsy usage was reduced and the extremely large stone (≥ 30 mm) clearance rate can be raised.

Keywords: Common bile duct stones, Extracorporeal shockwave lithotripsy, Endoscopic retrograde cholangiopancreatography, Cholecystokinin

Core tip: Extracorporeal shockwave lithotripsy (ESWL) and endoscopic retrograde cholangiopancreatography (ERCP) are frequently used for patients with large common bile duct (CBD) stones. Cholecystokinin can relax the sphincter of Oddi by binding to its inhibitory receptors. The effect of cholecystokinin (CCK) during ESWL on CBD stone clearance in the following ERCP has not previously been reported. The results of our research suggested that CCK during ESWL can aid the clearance of CBD stones in the first ESWL/ERCP session. Additionally, mechanical lithotripsy usage was reduced and the extremely large stone (≥ 30 mm) clearance rate can be raised.