In a consecutive series of 870 patients having cholecystectomy performed by the laparoscopic technique in a single surgical unit, prospective data collection has permitted analysis of the relationship between common bile duct (CBD) diameter, as measured pre-operatively by ultrasound (US) examination, and the frequency of CBD stones. Overall, 85 patients (9.8%) have been shown to have CBD stones; the interval frequency for CBD size 0-4, 4.1-6, 6.1-8, 8.1-10 and > 10 mm, was 3.9, 9.4, 28, 32 and 50%, respectively. Because most patients have small ducts (736 with CBD size < 6.1 mm) almost half (42) of those with CBD stones came from this group. In reporting CBD size as “not dilated’, radiologists should remind clinicians that this does not equate with “no CBD stones’.
Previously, there have been two reports concerning risk factors for the development of acute suppurative cholangitis (ASC) with CBD stones [13, 14]. The ASC diagnosis corresponds with severe cholangitis in the TG13. The reported risk factors identified were advanced age, presence of gallstones, current smoking, periampullary diverticlum, impacted bile duct stones and neurologic disease. However, the only factor that both reports identified was advanced age. Advanced age as a risk factor was excluded from our analysis, because it is one of the diagnostic factors for moderate cholangitis in the TG13. Moreover, identification of risk factors for moderate or severe cholangitis appeared to be more important than identification of risk factors for ASC for use in clinical settings, because ASC is a life-threatening status that should be avoided at all costs. In this sense, our analysis and identification of one factor, CBD dilatation, for the development of moderate or severe cholangitis is unique and should prove to be very helpful in clinical practice.
CBD, common bile duct; EST, endoscopic sphincterotomy.
To identify differences between patients with CBD stones who required and did not require emergent endoscopic management, the following clinical factors were analyzed: gender, smoking status, alcohol consumption, diabetes, presence of gallstones, CBD dilation, size and number of CBD stones, history of EST and presence of periampullary diverticlum.
In this study, clinical characteristics of consecutive patients with CBD stones treated in a single tertiary center who required and did not require emergent drainage were compared retrospectively. Moreover, the risk factors among patients with silent CBD stones for the development of cholangitis requiring emergent drainage were identified.
CBD, common bile duct; OR, odds ration; CI, confidence interval.
Endoscopic biliary drainage is an established mode of treatment for acute cholangitis, having high success rates and low morbidity and mortality [6-8]. Recent advances in and utilization of endoscopic biliary tract drainage along with the administration of antimicrobial agents have contributed to a decrease in the number of deaths due to acute cholangitis. However, it remains a life-threatening disease unless biliary tract drainage is performed in a timely manner.
Therefore, understanding differences between patients with CBD stones who require and do not require emergent drainage and identifying factors that contribute to occurrence of cholangitis requiring emergent drainage among patients with silent bile duct stones may be helpful for determining appropriate management strategies.
CBD, common bile duct.
Some patients with common bile duct (CBD) stones develop cholangitis requiring drainage, while others do not. The aims of this study were to elucidate the clinical differences among patients with CBD stones who required and did not require emergent drainage, and to identify risk factors for the development of cholangitis requiring emergent drainage in patients with silent CBD stones.