Abstract
Common bile duct (CBD) stone is a relatively frequent disorder with a prevalence of 10–20% in patients with gallstones. This is also associated with serious complications, including obstructive jaundice, acute suppurative cholangitis, and acute pancreatitis. Early diagnosis and prompt treatment is the most important for managing CBD stones. According to a recent meta-analysis, endoscopic ultrasonography and magnetic resonance cholangiopancreatography have high sensitivity, specificity, and accuracy for the diagnosis of CBD stones. Endoscopic ultrasonography, in particular, has been reported to have higher sensitivity between them. A suggested management algorithm for patients with symptomatic gallstones is based on whether they are at low, intermediate, or high probability of CBD stones. Single-stage laparoscopic CBD exploration and cholecystectomy is superior to endoscopic retrograde cholangiopancreatography (ERCP) plus laparoscopic cholecystectomy with respect to technical success and shorter hospital stay in high risk patients with gallstones and CBD stones, where expertise, operative time, and instruments are available. ERCP plus laparoscopic cholecystectomy is usually performed to treat patients with CBD stones and gallstones in many institutions. Patients at intermediate probability of CBD stones after initial evaluation benefit from additional biliary imaging. Patients with a low probability of CBD stones should undergo cholecystectomy without further evaluation. Endoscopic sphincterotomy and endoscopic papillary balloon dilation in ERCP are the primary methods for dilating the papilla of Vater for endoscopic removal of CBD stones. Endoscopic papillary large balloon dilation is now increasingly performed due to the usefulness in the management of giant or difficult CBD stones. Scheduled repeated ERCP may be considered in patients with high risk of recurrent CBD stones.
References
1. Williams EJ, Green J, Beckingham I, et al. Guidelines on the management of common bile duct stones (CBDS). Gut. 2008; 57:1004–1021.
2. Copelan A, Kapoor BS. Choledocholithiasis: diagnosis and management. Tech Vasc Interv Radiol. 2015; 18:244–255.
3. Chung JB. Gallstone diseases. In: Diseases of the gallbladder and bile ducts. 1st ed.Paju: Koonja Publishing Inc.;2008. p. 153–163.
4. Anderson SW, Lucey BC, Varghese JC, Soto JA. Accuracy of MDCT in the diagnosis of choledocholithiasis. AJR Am J Roentgenol. 2006; 187:174–180.
5. Meeralam Y, Al-Shammari K, Yaghoobi M. Diagnostic accuracy of EUS compared with MRCP in detecting choledocholithiasis: a metaanalysis of diagnostic test accuracy in head-to-head studies. Gastrointest Endosc. 2017; 86:986–993.
6. van Dijk AH, de Reuver PR, Besselink MG, et al. Assessment of available evidence in the management of gallbladder and bile duct stones: a systematic review of international guidelines. HPB (Oxford). 2017; 19:297–309.
7. European Association for the Study of the Liver (EASL). EASL clinical practice guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 2016; 65:146–181.
8. Abboud PA, Malet PF, Berlin JA, et al. Predictors of common bile duct stones prior to cholecystectomy: a metaanalysis. Gastrointest Endosc. 1996; 44:450–455.
9. Barkun AN, Barkun JS, Fried GM, et al. Useful predictors of bile duct stones in patients undergoing laparoscopic cholecystectomy. Mcgill gallstone treatment group. Ann Surg. 1994; 220:32–39.
10. Hunt DR. Common bile duct stones in non-dilated bile ducts? An ultrasound study. Australas Radiol. 1996; 40:221–222.
11. Onken JE, Brazer SR, Eisen GM, et al. Predicting the presence of choledocholithiasis in patients with symptomatic cholelithiasis. Am J Gastroenterol. 1996; 91:762–767.
12. Tse F, Barkun JS, Barkun AN. The elective evaluation of patients with suspected choledocholithiasis undergoing laparoscopic cholecystectomy. Gastrointest Endosc. 2004; 60:437–448.
13. ASGE Standards of Practice Committee. Maple JT, BenMenachem T, et al. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc. 2010; 71:1–9.
14. Seitz U, Bapaye A, Bohnacker S, Navarrete C, Maydeo A, Soehendra N. Advances in therapeutic endoscopic treatment of common bile duct stones. World J Surg. 1998; 22:1133–1144.
15. Park CH, Jung JH, Nam E, et al. Comparative efficacy of various endoscopic techniques for the treatment of common bile duct stones: a network metaanalysis. Gastrointest Endosc. 2018; 87:43–57.
16. Omar MA, Abdelshafy M, Ahmed MY, Rezk AG, Taha AM, Hussein HM. Endoscopic papillary large balloon dilation versus endoscopic sphincterotomy for retrieval of large choledocholithiasis: a prospective randomized trial. J Laparoendosc Adv Surg Tech A. 2017; 27:704–709.
17. Disario JA, Freeman ML, Bjorkman DJ, et al. Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. Gastroenterology. 2004; 127:1291–1299.
18. Aburajab M, Dua K. Endoscopic management of difficult bile duct stones. Curr Gastroenterol Rep. 2018; 20:8.
19. Freeman ML. Complications of endoscopic retrograde cholangiopancreatography: avoidance and management. Gastrointest Endosc Clin N Am. 2012; 22:567–586.
20. Wojtun S, Gil J, Gietka W, Gil M. Endoscopic sphincterotomy for choledocholithiasis: a prospective single-center study on the short-term and long-term treatment results in 483 patients. Endoscopy. 1997; 29:258–265.
21. Hawes RH, Cotton PB, Vallon AG. Follow-up 6 to 11 years after duodenoscopic sphincterotomy for stones in patients with prior cholecystectomy. Gastroenterology. 1990; 98:1008–1012.
22. Ki HS, Park CH, Jun CH, et al. Feasibility of cap-assisted endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy. Gut Liver. 2015; 9:109–112.
23. Gómez V, Petersen BT. Endoscopic retrograde cholangiopancreatography in surgically altered anatomy. Gastrointest Endosc Clin N Am. 2015; 25:631–656.
24. Iwashita T, Nakai Y, Hara K, Isayama H, Itoi T, Park DH. Endoscopic ultrasound-guided antegrade treatment of bile duct stone in patients with surgically altered anatomy: a multicenter retrospective cohort study. J Hepatobiliary Pancreat Sci. 2016; 23:227–233.