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symptoms of cbd stone

Symptoms of cbd stone

Once popular, open surgical techniques have been superseded by endoscopic techniques. The most common treatment modality is ERCP, with duct cannulation and clearance rates reaching 98% in expert hands. 28 Intraoperative ERCP at the time of laparoscopic cholecystectomy (also called “laparoendoscopic rendezvous”) is practised in some centres. It may have advantages, but it presents substantial logistical challenges. It involves the placement of a wire through the cystic duct to the ampulla at the time of laparoscopic cholecystectomy to ensure successful ERCP cannulation.

The evaluation of common bile duct stones in patients with gallstone disease involves stratifying their probability of having a stone in the common bile duct to: low (< 10%), intermediate (10%–50%) or high (> 50%) 17 ( Table 1 ).

What treatment options are available?

On the basis of findings in the current literature, we propose a simplified algorithm for the management of patients with suspected common bile duct stones before laparoscopic cholecystectomy ( Figure 1 ). The algorithm is similar to one issued by the American Society for Gastrointestinal Endoscopy. 17 Several organizations have published guidelines on selected aspects of the management of common bile duct stones ( Table 3 ; 1 , 17 , 19 – 27 see also Appendix 4, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.110896/-/DC1).

When surgery is not an option and stones cannot be removed from the common bile duct by endoscopic methods alone, or when ERCP cannulation fails repeatedly, percutaneous transhepatic cholangiography can be used to facilitate access to the biliary tree through a rendezvous procedure. Targeted percutaneous lithotripsy can also be helpful, but oral dissolution therapy is only of historical interest because of its poor efficacy and safety.

Table 1:

Imaging modalities for detecting stones in the common bile duct 4

Symptoms of cbd stone

Li S, Zenlea T. Choledocholithiasis. In: Ferri FF, ed. Ferri’s Clinical Advisor 2022. Philadelphia, PA: Elsevier; 2022:368-369.

Fogel EL, Sherman S. Diseases of the gallbladder and bile ducts. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 146.

About 1 in 7 people with gallstones will develop stones in the common bile duct. This is the small tube that carries bile from the gallbladder to the intestine.

Treatment may involve:

Images

Your health care provider may order the following blood tests:

Gallstone in the bile duct; Bile duct stone

Call your provider if:

Alternative Names

Often, there are no symptoms unless the stone blocks the common bile duct. Symptoms may include:

Risk factors include a history of gallstones. However, choledocholithiasis can occur in people who have had their gallbladder removed.