Spontaneous Passage of Gallbladder
Calculi-Facilitation by Endoscopic Sphincterotomy

After Endoscopic sphincterotopy (ES) gallbladder motility increases leading to expulsion of crystals and stones. But this is not a universal phenomenon. We evaluated cholangiographic findings in patients emptying their gallbladder after ES for common bile duct (CBD) stones. Cholangiographic features of twenty patients expelling gallbladder calculi after ES were studied. Controls included 20 age and sex matched patients with gallstones and CBD stones, who did not expel gallstones after ES. Of 20 cases in study group, 9 recovered more than 20 stones each in the stool within 7 days of ES. Repeat ERCP showed empty gallbladder in all, whereas CBD was full of stones in 11 of the 20 cases. In the study group, low insertion of the cystic duct was more common (10 vs 0, p<0.04), the cystic duct made a narrow angle (20±5° vs 50±10°, p<0.04) with CBD before insertion and cystic duct diameter was higher (5 mm vs 2.5 mm, p<0.04) as compared to controls. We conclude that in patients undergoing ES with intact gallbladder and small gallbladder calculi, spontaneous emptying of gallbladder calculi occurs, if cystic duct is wider, has low insertion and makes narrow angle with CBD before insertion.

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Laparoscopic Primary Closure of Common Bile Duct Combined with Percutaneous Cholangiographic Drainage for Treating Choledocholithiasis

The American Surgeon ◽

10.1177/000313481007600521 ◽

2010 ◽

Vol 76 (5) ◽

pp. 517-521 ◽

Cited By ~ 2

Author(s):

Shing-Moo Huang ◽

Chung-Chin Yao ◽

Ya-Wen Cheng ◽

Ling-Yun Chen ◽

Huichin Pan ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Primary Closure ◽

Operation Time ◽

Tube Placement ◽

Control Group ◽

Study Group ◽

T Tube ◽

Cbd Stones ◽

The Common

The aim of this study was to compare the efficacy and safety of laparoscopic primary closure of the common bile duct (CBD) combined with percutaneous transhepatic cholangiographic drainage (PTCD) and laparoscopic choledocholithotomy with T-tube placement for the treatment of CBD stones. Between January 1991 and July 2002, 50 patients with choledocholithiasis and a CBD diameter larger than or equal to 1 cm underwent laparoscopic CBD explorations. The study group consisted of 10 patients undergoing laparoscopic primary closure of the CBD combined with PTCD. The control group consisted of 40 patients undergoing laparoscopic choledocholithotomy with T-tube placement. Parameters were compared statistically. The study group showed higher female/male ratio (6/4 vs 8/32, P = 0.02), less stone numbers (1.90 ± 0.88 vs 3.40 ± 1.65, P = 0.0078), shorter operation time (138 ± 37 minutes vs 191 ± 75 minutes, P = 0.014), and shorter postoperative stays (7 ± 3 days vs 10 ± 3 days, P = 0.0013). It seems that laparoscopic primary closure of the CBD combined with PTCD can shorten the operation time and postoperative stays as compared with laparoscopic choledocholithotomy with T-tube placement for the treatment of CBD stones.

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Laparoscopic Common Bile Duct Exploration for Choledocholithiasis During a Pregnancy: a Case Report

Acta Chirurgica Latviensis ◽

10.1515/chilat-2016-0017 ◽

2016 ◽

Vol 16 (1) ◽

pp. 41-43 ◽

Cited By ~ 1

Author(s):

Janis Lacis ◽

Ieva Rancane ◽

Haralds Plaudis ◽

Evita Saukane ◽

Guntars Pupelis

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Common Bile Duct ◽

Gallstone Disease ◽

Intraoperative Ultrasound ◽

Common Bile Duct Exploration ◽

Dynamic Imaging ◽

Gallbladder Motility ◽

Cbd Stones ◽

Nulliparous Women

SummaryIn population studies, gallstones are found in 6.5% to 8.4% of nulliparous women, and in 18.4% to 19.3% of women with two to three or more pregnancies (7). Approximately 1 in 500 to 1 in 635 women will require non-obstetrical abdominal surgery during their pregnancies. Pregnancy induced physiological hormonal changes are associated with a decrease of gallbladder motility and increased cholesterol saturation of bile, leading to biliary stone formation (12,6,8). Surgical approach nowadays is the method of choice in the management of symptomatic gallstone disease during pregnancy, preferably if possible surgery should be postponed to second trimester (7,8).Preoperative radiologic imaging using magnetic resonance cholangiopancreatography is the golden standard for patients with suspected choledocholithiasis, however, its application during pregnancy is limited (9). Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) may be used before, during or after laparoscopic cholecystectomy when it is indicated, but unfortunately, its application during pregnancy is associated with considerable number of complications concerning mother and fetus. Alternative approach has been developed and recommended for patients with the common bile duct (CBD) stones providing laparoscopic common bile duct exploration (LCBDE). Intraoperative cholangiography or intraoperative ultrasound (IOUS) are the methods currently used for detection of the CBD stones during laparoscopic cholecystectomy, however, IOUS can be considered as the method of choice during pregnancy (3).IOUS is a dynamic imaging modality that provides interactive and timely information during surgical procedures. Because the transducer is in direct contact with the organ being examined, high-resolution images can be obtained that are not degraded by air, bone, or overlying soft tissue (1).

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A New Technique of ERCP: Y-Shaped Endoscopic Sphincterotomy (EST) Using the Isolated-Tip Sphincterotome in Patients with Common Bile Duct (CBD) Stones

Gastrointestinal Endoscopy ◽

10.1016/s0016-5107(05)01198-3 ◽

2005 ◽

Vol 61 (5) ◽

pp. AB216 ◽

Cited By ~ 2

Author(s):

Sang-Heum Park ◽

Ji-Young Park ◽

Ho-Sung Lee ◽

Jae-Hak Lee ◽

Suck-Ho Lee ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Endoscopic Sphincterotomy ◽

New Technique ◽

Cbd Stones ◽

A New Technique

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Value of routine milking of cystic duct during laparoscopic cholecystectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20173726 ◽

2017 ◽

Vol 4 (9) ◽

pp. 2889

Author(s):

Mohammed Elbalshy ◽

Ahmed Gaber ◽

Mohamed S. Ammar ◽

Hatem Soltan

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Common Bile Duct ◽

Cystic Duct ◽

University Hospital ◽

Cbd Stones ◽

Liver Functions ◽

Postcholecystectomy Pain

Background: Cystic duct stones (CDS) although they are occasionally encountered during laparoscopic cholecystectomy (LC) and are not detected easily by preoperative investigations however it is worthy to detect them intra-operatively as they will decrease the incidence of postcholecystectomy pain and they will alarm us to the more serious common bile duct (CBD) stones. So, we aimed at this study to evaluate the role of cystic duct milking in detection of cystic duct stones and its significance.Methods: This study was performed on 150 cases with calcular cholecystitis at Menofia University hospital in the period from August 2015 to May 2017. All patients had undergone LC, cystic duct milking. On table cholangiogram was done for cases that showed CDS.Results: CDS were detected in 28 cases, preoperative investigations failed to detect any of them however retrospectively 19 cases (67.8%) of them revealed to have mild transient liver functions derangement associated with acute right hypochondrial pain. Wide cystic duct (more than 4 mm) was recorded in 3 cases (10.7%) out of 28 cases that showed CDS. The incidence of association of cystic duct stones and CBD stones was found in 10 cases (35.7%).Conclusions: CDS are occasionally encountered during LC. They can be removed easily by just milking of cystic duct before clipping. The benefit is to decrease the incidence of post-cholecystectomy pain as well as it alerts us towards the more serious CBD stones. So on-table cholangiogram at that time becomes mandatory to avoid missed stone.

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Factors related to the spontaneous passage of common bile duct stones through the papilla: a single-center retrospective cohort study

Journal of International Medical Research ◽

10.1177/03000605211058381 ◽

2021 ◽

Vol 49 (11) ◽

pp. 030006052110583

Author(s):

Songming Ding ◽

Shanjie Dong ◽

Hengkai Zhu ◽

Weilin Wu ◽

Yiting Hu ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Clinical Laboratory ◽

Demographic Data ◽

Gamma Glutamyl Transpeptidase ◽

Stone Size ◽

Cbd Stones ◽

Spontaneous Passage ◽

Group A ◽

Group B

Objective Common bile duct (CBD) stones can spontaneously pass through the papilla. This study explored factors associated with stone passage by comparing differences in the clinical features of stones retained in the CBD and excreted stones. Methods Data were retrospectively collected for all patients who were hospitalized in our center between March 2016 and May 2021 with clinical, laboratory, or imaging evidence of CBD stones. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and were classified into two groups: group A (stones extracted by ERCP, n = 86) and group B (stones discharged before ERCP, n = 15). Demographic data, biochemical and radiological findings were compared between the groups. Results Stone size (0.82 vs. 0.33 cm), and levels of total bilirubin (58.2 vs. 28.8 μmol/L), gamma-glutamyl transpeptidase (416.7 vs. 193.9 U/L), alkaline phosphatase (191.9 vs. 123.1 U/L), carbohydrate antigen 19-9 (603.7 vs. 37.2 U/mL), and α-L-fucosidase (37.4 vs. 22.6 U/L) were significantly higher in group A than in group B. Logistic regression analyses showed that stone size was the only factor significantly associated with spontaneous passage of CBD stones. Conclusions CBD stones less than 0.33 cm in size may be self-expelled through the papilla.

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Parameters Suggesting Spontaneous Passage of Stones from Common Bile Duct: A Retrospective Study

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2019/5382708 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Tawfik Khoury ◽

Mohamed Adileh ◽

Ashraf Imam ◽

Yosef Azraq ◽

Avital Bilitzky-Kopit ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Clinical Laboratory ◽

Medical Center ◽

Gamma Glutamyl Transferase ◽

Cbd Stones ◽

Spontaneous Passage ◽

Group A ◽

Group B ◽

Glutamyl Transferase

Background. Common bile duct (CBD) stones are common. However, they are known to pass spontaneously, which obviates the need for ERCP. Aim. The aim of this study is to identify specific predictors for spontaneous passage of CBD stones. Methods. Data was retrospectively collected for all patients who were hospitalized with clinical, laboratory, or ultrasonographic evidence of choledocholithiasis and who underwent magnetic resonance cholangiopancreatography (MRCP) in Hadassah Medical Center between 2005 and 2011. The patients were classified into 4 groups: group A (positive MRCP and positive ERCP), group B (positive MRCP but negative ERCP), group C (positive MRCP but did not undergo ERCP), and group D (negative MRCP that did not undergo ERCP) for choledocholithiasis. All positive MRCP-groups (A+B+C) were further grouped together into group E. We compared groups A versus B and groups E versus D. Results. Comparing groups A versus B, only gamma-glutamyl transferase predicted spontaneous passage of stones from CBD, as the level was significantly higher in group A (677±12.1) versus group B (362.4±216.2) (P=0.023). Patients with small stone diameter (P=0.001), distal stones (P=0.05), and absence of intrahepatic dilatation (P=0.047) tend to pass their stones spontaneously. Comparing groups D versus E, it was found that male gender (P=0.03), older age (P<0.001), high levels of GGT (P=0.022), high levels of alkaline phosphatase (P=0.011), high levels of total bilirubin (P=0.007), and lower levels of amylase (P<0.001) are predictors for positive MRCP studies for CBD stones. Conclusion. Identification of specific predictors is important to avoid unnecessary invasive endoscopic intervention.

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Surgical procedure for unexpected balloon burst complication during endoscopic balloon dilatation in a patient with common bile duct stones

Surgical Case Reports ◽

10.1186/s40792-020-01014-5 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Koji Morishita ◽

Hideaki Sasaki

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Balloon Dilatation ◽

Rare Complication ◽

Common Bile Duct Stones ◽

Endoscopic Retrograde ◽

Case Presentation ◽

Endoscopic Balloon Dilatation ◽

Cbd Stones ◽

Endoscopic Balloon

Abstract Background Endoscopic balloon dilatation (EBD) is the established treatment for common bile duct (CBD) stones. Although pancreatitis and bleeding have been reported as major complications of EBD, balloon-related complications are rarely reported in EBD. Case presentation A 30-year-old woman with suspected CBD stones underwent endoscopic retrograde cholangiopancreatography (ERCP) and EBD. During EBD, the balloon of the EBD catheter suddenly burst at the biliary sphincter. We therefore performed surgical intervention: removal of the broken EBD catheter and T-tube drainage. Finally, the patient was discharged without any complications. Conclusions We present a case involving a burst balloon of an EBD catheter as a rare complication during EBD, as well as the surgical technique that was used to treat this complication.

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