Twelve elderly, ill patients with large common bile duct stones and cholelithiasis were treated with endoscopically placed biliary endoprostheses after endoscopic attempts at stone removal were unsuccessful. The patients were classified according to the American Society of Anesthesiologists' Physical Status Classification criteria and were Classes III and IV. The endoscopic procedures were tolerated well without complication. Resolution of biliary symptoms occurred in all patients. After extended follow-up of up to 60 months, no patient has required surgery for biliary symptoms or complications. One patient died following elective biliary surgery, six others have died from nonbiliary causes. The results suggest that management of large common bile duct stones by endoprosthesis placement can be done safely, and satisfactory long-term outcomes can be achieved.
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