Research Article
Volume 7 Issue 2 - 2020
Efficacy of Medical Treatment by Glyceryl Trinitrate (GTN) in Management of a Small Stone in the CBD in Patients with Chronic Calcular Cholecystitis due to Spasm in Sphincter of Oddi
Mohamed Abdallah Zaitoun1, Mohamed Ibrahim Mansour1*, Amr Ibrahim1, Ehab M Oraby2, Heba F Tantawy3, Shady E Shaker4, Ahmed S Allam4 and Ahmed M Elsayed5
1Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
2Department of General Surgery, Faculty of Medicine, Benha University, Benha, Egypt
3Department of Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
4Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
5Department of Tropical Medicine, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Mohamed Ibrahim Mansour, Department of General Surgery, Faculty of Medicine, Zagazig University Zagazig, Egypt.
Received: December 11, 2019; Published: January 11, 2020




Abstract

Background: Early detection of stones in the common bile duct (CBD) in patients with chronic calcular cholecystitis and adequate management of them are important to decrease patients’ morbidity. In some patients a spasm in sphincter of oddi might lead to entrapment of a small stone which could be managed medically without surgical intervention. Glyceryl trinitrate (GTN) was found to dilate blood vessels and sphincter of oddi. 

Aims: To evaluate the benefits of using GTN in management of a small stone in the CBD in patients with chronic calcular cholecystitis aiming to avoid unnecessary surgery.

Patients and Methods: We performed our study on 30 patients having chronic calcular cholecystitis with CBD stone. We give them GTN as medical treatment daily for about one week. We followed them for 7 days for clinical, laboratory and sonographic improvement.

Results: We found that 25 (83.3%) of our patients have clinical, laboratory and sonographic evidence of improvement of symptoms in a median time of 4 - 5 days (p = 0.001) and then ERCP and cholecystectomy was done later on. While 5 (16.7%) cases revealed elevated pancreatic enzymes which denoted failed medical management with persistence of the stone and needed ERCP then cholecystectomy later on (p = 0.001). There was a significant association between patients with succeeded medical treatment and patients with failed medical treatment regarding size of the stone and age of the patient (p = 0.001). Ultrasonography showed significant reduction in CBD diameter (p = 0.001) during GTN treatment. 

Conclusion: Small stone in the CBD might be resulted from a spasm in sphincter of oddi and could be effectively managed by medical treatment using GTN which could result in a clinical recovery of most patients and ERCP and cholecystitis could be done later on.

Keywords: Chronic Calcular Cholecystitis; Common Bile Duct Stone; Spasm in Sphincter of Oddi GTN Therapy

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Citation: Mohamed Ibrahim Mansour., et al. “Efficacy of Medical Treatment by Glyceryl Trinitrate (GTN) in Management of a Small Stone in the CBD in Patients with Chronic Calcular Cholecystitis due to Spasm in Sphincter of Oddi”. EC Gastroenterology and Digestive System 7.2 (2020): 01-07.

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