Detection of Common Bile Duct Stones in Mild Acute Biliary Pancreatitis Using Magnetic Resonance Cholangiopancreatography

Background. All patients with mild acute biliary pancreatitis should undergo early cholecystectomy. Whether routine common bile duct (CBD) imaging should be employed before the surgical procedure in these patients is a matter of current controversy. The aim of this study was to investigate the rate of detection of CBD stones using magnetic resonance cholangiopancreatography (MRCP) at different time intervals from admission. Methods. From January 1, 2011, through December 31, 2016, 72 patients with acute biliary pancreatitis underwent MRCP. Fifty-six (n=56) of them with mild biliary pancreatitis met the study criteria. The patients were divided into two groups. Group A did not have stones in the CBD (n=45), and Group B had stones in the CBD (n=11). The time from admission to MRCP was divided into several periods (day 1 through day 180), and the presence of the CBD stones on MRCP was weighted against remoteness from admission. Liver chemistry profiles were compared between the groups on admission and before the MRCP. Results. The cumulative rate of choledocholithiasis was 19.7% (Group B, n=11). Forty-five patients (Group A, n=45, 80.3%) did not have gallstones in the CBD. Eight patients with choledocholithiasis (8/56, 14.2%) were detected during the first 10 days from admission out of 27 patients. In patients who underwent MRCP between days 11 and 20, choledocholithiasis was found in two patients (2/56, 3.5%) and in one patient between days 21 and 30 (1/56, 1.8%). No stones were found in patients who underwent MRCP beyond 30 days from admission. Liver chemistry profiles did not show a significant difference in both groups. CBD dilatation was observed at presentation in 11 patients (n=11/56), 6 in Group A (6/45, 13.3%) and 5 in Group B (5/11, 45.5%) (p=0.016). Conclusions. Routine CBD evaluation should be encouraged after mild acute biliary pancreatitis. Early performance of MRCP gives high yield in selecting the patients for endoscopic retrograde cholangiopancreatography (ERCP) before cholecystectomy. A liver chemistry profile either on admission or before MRCP cannot predict the presence of CBD stones.

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Accuracy of Ultrasound and Magnetic Resonance Cholangiopancreatography Findings in the Diagnosis of Biliary System Stones

Pertanika Journal of Science and Technology ◽

10.47836/pjst.30.1.46 ◽

2022 ◽

Vol 30 (1) ◽

pp. 841-852

Author(s):

Abdullah Taher Naji ◽

Ameen Mohsen Amer ◽

Saddam Mohammed Alzofi ◽

Esmail Abdu Ali ◽

Noman Qaid Alnaggar

Keyword(s):

Bile Duct ◽

Magnetic Resonance ◽

Common Bile Duct ◽

Common Bile Duct Stones ◽

Magnetic Resonance Cholangiopancreatography ◽

Final Diagnosis ◽

Biliary System ◽

Cbd Stones ◽

System Diagnosis ◽

Us Findings

This study aimed to evaluate the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) and Ultrasound (US) images for the diagnosis of biliary system stones, as well as to assess the consistency between MRCP and US findings. The study sample included 200 cases (90 males and 110 females) with symptomatic biliary system stones between 14 and 82 years. All cases underwent both the US and MRCP imaging for biliary system diagnosis. The study revealed that the most prominent age group with symptoms of biliary system stones was the 33-60-year-old group. It also found that the accuracy of US and MRCP in detecting gallbladder (GB) stones compared with the final diagnosis was 94% and 91%, respectively, with moderate conformity between their results. The accuracy of US and MRCP images in detecting common bile duct (CBD) stones was 61% and 98%, respectively, with fair conformity between their results. In addition, there is a significant agreement between the MRCP and US results in detecting the GB and CBD stones with an agreed percentage of 74% and 71%, respectively. The study concluded that US is the preferred imaging technique for patients with symptomatic gallbladder stones, whereas MRCP is a trustworthy investigation for common bile duct stones.

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Adding ursodeoxycholic acid to the endoscopic treatment and common bile duct stenting for large and multiple biliary stones: Will it improve the outcomes?

BMC Gastroenterology ◽

10.1186/s12876-020-01523-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Ahmad Hormati ◽

Mohammad Reza Ghadir ◽

Seyed Saeed Sarkeshikian ◽

Faezeh Alemi ◽

Majid Moghaddam ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Ursodeoxycholic Acid ◽

The Elderly ◽

Success Rates ◽

Biliary Stones ◽

Cbd Stones ◽

Group A ◽

Bile Duct Stenting ◽

Group B

Abstract Background The role of common bile duct (CBD) stenting in the establishment of bile stream in the elderly patients and the ones who are not good candidates for surgery due to not responding to treatments was well documented in previous studies. The current study aimed at investigating the effect of adding Ursodeoxycholic acid (UDCA) to CBD stenting alone in order to reduce the size of large and multiple CBD stones. Methods Clinical outcomes including success rates in CBD stones clearance, incidence of pancreatitis, perforation, bleeding, as well as, decrease in size of stones and liver enzymes after a two-month period were assessed in the UDCA + CBD stenting group. Results A total of 64 patients referring to Shahid Beheshti Hospital in Qom, Iran with multiple or large CBD stones (above three or larger than 15 mm) received standard endoscopic therapies and UDCA + CBD stenting (group B) and controls only received standard endoscopic therapies with only CBD stenting (group A). The mean reduction in the size of stones in group B was significantly higher than that of group A (3.22 ± 1.31 vs 4.09 ± 1.87 mm) (p = 0.034). There was no difference in the incidence rate of complications including pancreatitis, cholangitis, bleeding, and perforation between the two groups (P > 0.05). Conclusion Adding UDCA to CBD stenting, due to decrease in the stone size and subsequently facilitation of the stones outlet, can be considered as the first-line treatment for patients with large and multiple CBD stones. Also, in the cases with large or multi stones may be effective in reducing size and subsequently stone retrieval. Trial registry The study protocol was approved by the Ethics Committee of Qom University of Medical Sciences (ethical code: IR.MUQ.REC.1397.075); the study was also registered in the Iranian Registry of Clinical Trials (No. IRCT20161205031252N8). This study adheres to CONSORT guidelines.

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Primary Closure Versus T-Tube Drainage Following Laparoscopic Common Bile Duct Exploration in Patients With Previous Biliary Surgery

The American Surgeon ◽

10.1177/0003134820947396 ◽

2020 ◽

pp. 000313482094739

Author(s):

Wan Zhen ◽

Wang Xu-Zhen ◽

Fu Nan-Tao ◽

Li Yong ◽

Xiao Wei-Dong ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Primary Closure ◽

Common Bile Duct Exploration ◽

Biliary Surgery ◽

Tube Drainage ◽

T Tube ◽

Significant Difference ◽

Group A ◽

Group B

Laparoscopic common bile duct exploration (LCBDE) has been recently introduced for management of CBD stone in patients with previous biliary surgery history. The aim of this study was to evaluate the safety and effectiveness of primary closure in patients with previous biliary surgery history compared to T-tube drainage. Eighty patients with previous biliary surgery history including laparoscopic cholecystectomy, open cholecystectomy, or open common bile duct exploration were enrolled in the retrospective study. The patients were divided into 2 groups according to the methods of choledochotomy closure. Group A: patients with primary closure after LCBDE (n = 51); group B: patients with T-tube drainage after LCBDE (n = 29). Group A exhibited a shorter postoperative hospital stay and lower hospitalization expenses compared to group B. There was no significant difference in conversion rate to open surgery, operating time, intraoperative blood loss, bile leakage rate, overall complication rate, and stone recurrence rate between the 2 groups. Biliary stricture was not observed in the 2 groups during the follow-up period. Primary closure following LCBDE is safe and effective for the management of CBD stones in patients with previous biliary surgery history.

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Early versus Delayed Single-Stage Laparoscopic Eradication for Both Gallstones and Common Bile Duct Stones in Mild Acute Biliary Pancreatitis

The American Surgeon ◽

10.1177/000313480507100812 ◽

2005 ◽

Vol 71 (8) ◽

pp. 682-686 ◽

Cited By ~ 9

Author(s):

John Griniatsos ◽

Evangelos Karvounis ◽

Alberto Isla

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Common Bile Duct ◽

Single Stage ◽

Definitive Treatment ◽

Morbidity Rate ◽

Biliary Pancreatitis ◽

Acute Biliary Pancreatitis ◽

Laparoscopic Management ◽

Significant Difference

Several studies addressed that preoperative endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct (CBD) clearance, followed by interval laparoscopic cholecystectomy (two-stage approach), constitutes the most common practice in cases of uncomplicated mild acute biliary pancreatitis. Between June 1998 and December 2002, 44 patients (35 females and 9 males with a median age of 62 years) suffering from uncomplicated mild acute biliary pancreatitis were treated in our unit. All patients were electively submitted to surgery after subsidence of the acute symptoms, and for definitive treatment we favored the single-stage laparoscopic management, avoiding preoperative ERCP. All patients underwent laparoscopic cholecystectomy plus fluoroscopic intraoperative cholangiogram (IOC). If filling defect(s) were detected in the IOC, a finding suggestive of concomitant choledocholithiasis, laparoscopic common bile duct exploration (LCBDE) was added in the same sitting. Twenty patients were operated upon within 2 weeks since the attack of the acute symptoms and constitute the early group (n = 20), whereas 24 patients underwent an operation later on and constitute the delay group (n = 24). We retrospectively compare the safety, effectiveness, and outcome after the single-stage laparoscopic management between the two groups of patients. Laparoscopic cholecystectomy alone constituted the definitive treatment in 38 patients, while an additional LCBDE was performed in the remaining 6 patients (14%), and all operations were achieved laparoscopically. There was no statistically significant difference between the groups in terms of operative time, incidence of concomitant choledocholithiasis, morbidity rate, and postoperative hospital stay. During the follow-up, none of the patients experienced recurrent pancreatitis. In uncomplicated mild acute biliary pancreatitis cases, a single-stage definitive laparoscopic management, avoiding preoperative ERCP, can be safely performed during the same admission, after the improvement of symptoms and local inflammation. Postoperative ERCP should be selectively used in patients in whom the single-stage method failed to resolve the problem.

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Diagnostic value of magnetic resonance cholangiopancreatography to detect bile duct stones in acute biliary pancreatitis

Pancreatology ◽

10.1016/j.pan.2014.05.711 ◽

2014 ◽

Vol 14 (3) ◽

pp. S98

Author(s):

Hyung-Keun Kim ◽

Hyuk-Min Kwon ◽

Young-Seok Cho ◽

Sung-Soo Kim ◽

Hiun-Suk Chae

Keyword(s):

Bile Duct ◽

Magnetic Resonance ◽

Magnetic Resonance Cholangiopancreatography ◽

Diagnostic Value ◽

Biliary Pancreatitis ◽

Bile Duct Stones ◽

Acute Biliary Pancreatitis

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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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Two-stages using endoscopic retrograde cholangio-pancreatography procedures versus single stage laparoscopic management for concomitant gallstones and common bile duct stones

International Surgery Journal ◽

10.18203/2349-2902.isj20195381 ◽

2019 ◽

Vol 6 (12) ◽

pp. 4244 ◽

Cited By ~ 1

Author(s):

Ahmed Abdel Kahaar Aldardeer ◽

Alaa A. Redwaan

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Single Stage ◽

Complication Rates ◽

Bile Duct Stones ◽

Two Stage ◽

Endoscopic Retrograde ◽

Cbd Stones ◽

Group A ◽

Group B

Background: Laparoscopic common bile duct exploration (LECBD) has been proven to be a safe, reliable, and effective treatment for common bile duct (CBD) stones and has gained wider acceptance. Endoscopic retrograde cholangio-pancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) is safe and efficient method that has been usually used for the treatment of bile duct stones. The aim of this study is to compare the outcome of management of concomitant gallstones and common bile duct by two stage (ERCP+LC) versus one stage (LECBD+LC).Methods: This study included 150 patients with concomitant gallstones and CBD stones who were treated at sohag university hospital from July 2017 to December 2018. Results were statistically analysed.Results: The success rates of laparoscopic CBD exploration and ERCP for clearance of CBD were similar (Group A 96% vs. Group B 97.3%). The mean operative time was significantly longer in-group A (125.7±36.6 min) vs. in-group B (82.4±27.6 min), Group A as regard intraoperative complications (one patient had hemorrhage) vs. group B (2 patients hemorrhage during lap. cholecystectomy). As for conversion to other procedure 2 patients for group A vs. 3 patients for group B (conversion of LC to open).Conclusions: Single and two-stage management for uncomplicated concomitant gallbladder and CBD stones had similar success and complication rates, but the single stage strategy was better in terms of shorter hospital stay, need for fewer procedures, less morbidity, and allows earlier recovery with a reduced period of short-term disability.

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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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