Clinical Practice Guidelines for Common bile duct stones: The evaluation of CBD stones

Background/Aims: Choledocholithiasis is a common complication of cholecystolithiasis, occurring in 15-20% of patients who have gallbladder stones. Endoscopic retrograde cholangio-pancreatography is the standard treatment. When this is not possible or not feasible, percutaneous transhepatic stone removal is an alternative treatment. In this retrospective study, we analyze 110 patients who were treated with percutaneous transhepatic removal of Common Bile Duct (CBD) stones. Patients and Methods: Between March 1998 and September 2013 110 patients (61 men, 49 women; aged 14-96, mean age 69.7 years) with confirmed bile duct stones were included. PTC was done using ultrasound and fluoroscopy. Balloon dilatation of the papilla was done with 8-12 mm balloons. If stone size exceeded 10 mm, mechanical lithotripsy was performed. Stones were then removed by percutaneous extraction or evacuation into the duodenum. Results: In 104 patients (104/110; 94.5%) total stone clearance of the CBD was achieved. A total of 12 complications occurred (10.9%), graded with the Clavien-Dindo scale as IVa, IVb, and V, respectively; hypoxia requiring resuscitation, sepsis and death due to ongoing cholangiosepsis (n = 1, 4, 1). Minor complications I, II, and IIIa included: small liver abscess, pleural empyema, transient hemobilia and mild fever (n = 1, 1, 2, 2). Conclusion: Percutaneous removal of CBD stones is an effective alternative treatment, when endoscopic treatment is contra-indicated, fails or is not feasible. It is effective, has a low complication rate and using deep sedation potentially requires only a very limited number of treatment sessions.

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Evaluation of different methods of laparoscopic treatment of common bile duct stones

International Surgery Journal ◽

10.18203/2349-2902.isj20193306 ◽

2019 ◽

Vol 6 (8) ◽

pp. 2670

Author(s):

Elghamry E. Elghamry ◽

Mohamed M. Elsheikh ◽

Hamdy A. Mohamed

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Primary Repair ◽

Common Bile Duct Stones ◽

Bile Leakage ◽

Biliary Colic ◽

Bile Duct Stones ◽

Cbd Stones ◽

The Mean ◽

Cbd Exploration

Background: Common bile duct (CBD) stones are the second most common complication of gall bladder stones. The best management of patients with CBD stones remains controversial. The aim of this study was to evaluate the methods of laparoscopic CBD exploration (LCBDE).Methods: This prospective study was conducted on 30 patients with CBD stones through 2 years. CBD stricture was excluded. Authors used transcystic and transcholedochotomy approaches for LCBDE either with or without choledoschope. Primary repair of the choledochotomy incision was done. Results: The mean age was 48.90±11.84 years. Biliary colic was the presentation in 63.3% of patients. The transcystic approach for CBD exploration was used in 16 cases without conversion, 11 cases were completed without choledochoscope, while 5 cases with choledochoscopic guided extraction. Choledochotomy approach had been used in 13 cases, 6 cases were completed with choledochoscope and 7 cases without it, two cases of them failed. One case failed from the beginning and was converted to open exploration. 5 ERCP previously inserted stents were removed. The mean operative time was 162.33±74.67 min. Bile leakage occurred in 2 cases following the choledochotomy approach. The mean hospital stay was 3.37±1.38 days.Conclusion: LCBDE is a feasible, effective and safe approach to bile duct stones. Depending on proper training and gaining experience.

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LAPAROSCOPIC MANAGEMENT OF COMMON BILE DUCT STONES

10.36106/ijsr/7223545 ◽

2020 ◽

pp. 1-4

Author(s):

Binit Prasad ◽

Mukesh Kumar ◽

Debarshi Jana

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Open Surgery ◽

Common Bile Duct Stones ◽

Single Stage ◽

Bile Duct Stones ◽

Cbd Stones ◽

Cbd Stone ◽

Laparoscopic Cbd Exploration ◽

Cbd Exploration

Introduction: Common Bile Duct stones (CBD) are found in approximately 16% of the patients undergoing Laparoscopic cholecystectomy (LC). Till recently, the gold standard for treating CBD stones was endoscopic removal, if that failed, then open surgery. However, in the laparoscopic era, the best treatment for CBD stones is a matter of debate and it continues to evolve. The objective of the present study is to determine that laparoscopic CBD exploration (LCBDE) is a safe, feasible and single-stage option for the management of CBD stones. Materials and Methods :Out of the 2900 laparoscopic cholecystectomies we did selective intraoperative cholangiogram in 262 patients who were suspected to have CBD stones based on deranged liver function tests, dilated CBD with or without CBD stone on sonography or having the history of recent jaundice/pancreatitis. If CBD stone was found, either a transcystic or transcholedochal exploration was done depending on the size, site, number of stones and CBD diameter. Choledochotomy was closed over a t-tube in the majority of the patients. Primary closure of CBD was done in few patients and in one patient we placed an antegrade stent and in another we placed endoscopic stent into the CBD laparoscpically which was removed after four weeks. Results :Till date we have performed LCBDE in 64 patients. Transcystic exploration was done in 14 patients and transcholedochal exploration was done in 46 cases out of which 2 patients had minor biliary leak which settled on conservative treatment in 2-3 days. Four patients required conversion to open surgery as there were multiple stones. We did not have any major complication and on 6 months follow-up in 76% patients, none was found to have residual stone. Conclusion :The treatment of CBD stones depends on the resources available, technical limitations and the surgeon’s expertise. Laparoscopic CBD exploration is a safe, feasible and single-stage option for the management of CBD stones.

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Clinical Practice Guideline for Common Bile Duct Stones: Diagnosis and Treatment

Korean Journal of Gastroenterology ◽

10.4166/kjg.2018.72.1.6 ◽

2018 ◽

Vol 72 (1) ◽

pp. 6

Author(s):

Sung Ill Jang ◽

Dong Ki Lee

Keyword(s):

Clinical Practice ◽

Bile Duct ◽

Common Bile Duct ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

Common Bile Duct Stones ◽

Diagnosis And Treatment ◽

Bile Duct Stones

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CONCOMITANT GALLSTONES AND COMMON BILE DUCT STONES: SHOULD SINGLE-STEP LAPAROSCOPIC CHOLECYSTECTOMY IMMEDIATELY AFTER THE ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY?

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.6.13 ◽

2018 ◽

Vol 8 (6) ◽

pp. 99-104

Author(s):

Vy Pham Trung ◽

Hiep Pham Nhu ◽

Vu Pham Anh ◽

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Common Bile Duct ◽

Common Bile Duct Stones ◽

Single Step ◽

Bile Duct Stones ◽

Endoscopic Retrograde ◽

Female Ratio ◽

Cbd Stones ◽

Study Results

Purpose: To evaluate results from treatment of concomitant gallstones and common bile duct (CBD) stones by ERCP and laparoscopic cholecystectomy. Analysis of single-step or separated-step characteristics. Object: During the 3 years (2015-2017), 285 patients CBD stones concomitant or not gallstones underwent ERCP, 68 patients concomitant gallstones and CBD suitable criteria for inclusion at Hue Central Hospital. Retrospective clinical descriptive study. Results: Average age 52.2±12.5 (24-90), male/female ratio of 0.7/1 (27/41). Abdominal pain was the most common symptom 91.2%, jaundice 51.5%, direct bilirubin increased 27.3±15.6μmol/l (2.2-165). The diameter of CBD stone is 12.4±3.2mm (6-20), gallstones size 11.3±6.2mm (536). The first time CBD stones 95.6%, recurrence CBD stones 4.4%. ERCP and laparoscopic cholecystectomy (LC) 34patients, ERCP 1.4±2.5times and secondary LC. Single-step ductal clearance 76.5%, separatestep ductal clearance 94.1% (p=0.041). Length of hospital stay 6.5±4.3days and 13.6±2.2days (p<0.0001). Conclusions: The percentage of ductal clearance in the separate-step patients group was higher than that single-step patients group with p=0.041. The indication of cholecystectomy immediately endoscopic retrograde cholangio pancreatography should be based on the patient status, the ductal clearance as well as the complications. Key words: Common bile duct stones, Endoscopic retrograde cholangio pancreatography

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Comparable Safety of ERCP in Symptomatic and Asymptomatic Patients with Common Bile Duct Stones: A Propensity-Matched Analysis

10.21203/rs.3.rs-45622/v1 ◽

2020 ◽

Author(s):

Lina Xiao ◽

Chong Geng ◽

Xiao Li ◽

Yanni Li ◽

Chunhui Wang

Keyword(s):

Bile Duct ◽

Postoperative Complications ◽

Common Bile Duct ◽

Acute Cholangitis ◽

Common Bile Duct Stones ◽

Bile Duct Stones ◽

Endoscopic Retrograde ◽

Cbd Stones ◽

Asymptomatic Patients ◽

Before And After

Abstract Background: The safety of endoscopic retrograde cholangiopancreatography (ERCP) for asymptomatic common bile duct (CBD) stones patients has not been fully studied. This study aimed to compare the incidence and severity of ERCP complications in patients with asymptomatic and symptomatic CBD stones and to provide evidence for the treatment of asymptomatic CBD stones.Methods: The clinical data of patients were retrospectively analyzed. These patients were divided into the asymptomatic CBD stones group and the symptomatic CBD stones group. Propensity score matching (PSM) was used to match the two groups. The incidence and severity of postoperative complications of ERCP in the two groups were analyzed.Results: A total of 79 patients who had asymptomatic CBD stones and 795 patients who had symptomatic CBD stones were included in this study. After PSM, 79 patients from asymptomatic CBD group and 316 patients from the symptomatic CBD stones group were identified. Before and after PSM, there were no significant differences in the incidence and severity of post-ERCP pancreatitis (PEP) between the two groups (P> 0.05). Besides, the incidence and severity of other complications including acute cholangitis, bleeding and perforation in the two groups was no differences before and after PSM (P>0.05).Conclusions: Patients with asymptomatic CBD stones are not at higher risk of getting ERCP-related complications when compared with those with symptomatic ones. ERCP is as safe and effective for asymptomatic CBD stones as for symptomatic patients.

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