Choledocholithiasis: Evaluation, Treatment, and Outcomes

Molvar, Christopher; Glaenzer, Bryan

doi:10.1055/s-0036-1592329

Cited by 56 publications

(26 citation statements)

References 83 publications

(86 reference statements)

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“…However, the recognition of choledocholithiasis is important, as it is associated with cholangitis and obstructive pancreatitis, increasing the risk of death nine-fold as compared to patients with uncomplicated gallstones [2-3]. The management of patients with suspected choledocholithiasis has been controversial, involving a variety of open surgical, minimally invasive surgical (such as laparoscopic and robotic), endoscopic, and ultrasonic modalities [4-5]. While open or minimally invasive surgical techniques provide an effective treatment of choledocholithiasis at the same time as cholecystectomy, they often involve choledochotomy and instrumentation with inflexible laparoscopic tools, such as retrieval baskets, which can cause damage to the biliary tree if too much force is applied.…”

Section: Introductionmentioning

confidence: 99%

Novel Technique for Laparoscopic Common Bile Duct Exploration Using Endovascular Instrumentation

Copeland

Blears

Zhu

et al. 2019

Cureus

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Treatment of choledocholithiasis is sometimes a two-step process involving both surgeons and gastroenterologists. Common bile duct (CBD) exploration can be performed at the same time as cholecystectomy but often requires the use of rigid tools, increasing the risk of CBD damage. Here, we report the case of a 64-year-old man who presented with epigastric pain and a positive Murphy's sign. Ultrasonography revealed cholecystitis with cholelithiasis. Gangrenous cholecystitis was visualized upon surgical exploration, and an intraoperative cholangiogram diagnosed likely choledocholithiasis. Cholecystectomy was completed, and CBD exploration was performed by the manipulation of endovascular equipment using a trans-cystic approach through to the ampulla of Vater, and the patient made a complete recovery without complications. The substantial flexibility, gentleness, and durability of endovascular instruments allow for minimal tension on structures during the removal of gallstones from the CBD, providing safe, definitive treatment for choledocholithiasis during cholecystectomy.

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Section: Introductionmentioning

confidence: 99%

Novel Technique for Laparoscopic Common Bile Duct Exploration Using Endovascular Instrumentation

Copeland

Blears

Zhu

et al. 2019

Cureus

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“…Конкременты ОЖП приводят к таким серьезным осложнениям, как механическая желтуха, острый билиарный панкреатит, холангит, холангиогенные абсцессы печени и вторичный билиарный цирроз. Эти осложнения могут стать фатальными [4].…”

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Successful endoscopic treatment of giant multiple choledocholithiasis using oral transpapillary cholangioscopy and intraductal contact lithotripsy

et al. 2023

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Êëèíè÷åñêîå íàáëþäåíèå / Case reportПредставлено клиническое наблюдение успешного этапного эндоскопического лечения при гигантском множественном холедохолитиазе. Традиционное хирургическое вмешательство было противопоказано пациентке ввиду выраженных сопутствующих заболеваний и большого анестезиологического риска. Базовым методом мини-инвазивного лечения была контактная литотрипсия, дополненная баллонной дилатацией зоны эндоскопической папиллосфинктеротомии и механической внутрипротоковой литотрипсией. Применение контактной литотрипсии при пероральной транспапиллярной холангиоскопии в сочетании с другими современными способами эндоскопического лечения холедохолитиаза обладает хорошим техническим и клиническим эффектом даже при гигантских размерах билиарных конкрементов.

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“…В разі несвоєчасної діагностики та ліквідації ХЛ у цих пацієнтів можливий розвиток таких грізних ускладнень, як гострий холангіт і біліарний сепсис, які реєструються приблизно в 60% і 20% випадків відповідно, призводять до поліорганної дисфункції та характеризуються високою (41-53%) летальністю [1,9,11].…”

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“…До теперішнього часу потребують доопрацювання критерії визначення черговості, етапності та обсягу діагностичних заходів щодо діагностики ХЛ та його ускладнень, а також узгодженої патогенетично обґрунтованої лікувальної тактики [2,5,11,12].…”

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Gallstone Disease Complicated by Choledocholithiasis: Modern Aspects of Diagnostics

Borysenko¹

2021

Ukr. ž. med. bìol. sportu

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Choledocholithiasis is an urgent problem of modern hepatobiliary surgery and accounts for 60% of all obstructive jaundice. Stones of the common bile duct cause cholestasis and mechanical jaundice syndrome and in case of untimely diagnostics lead to the development of such severe complications as acute cholangitis and biliary sepsis. The criteria for determining the sequence, stages and volume of diagnostic measures with choledocholithiasis have not been determined by now. The purpose of the study. Optimization of the instrumental stage of the diagnostics of patients with choledocholithiasis. Materials and methods. 56 patients with choledocholithiasis were studied. The diagnostic program was expanded due to the instrumental stage using ultrasound, duodenopapiloscopy, endoscopic retrograde cholangiopancreatography and magnetic resonance tomography. The criterion for the patients selection was the syndrome of distal choledochal patency violation and the presence of stones in it according to echosonography and endoscopic cholangiopancreatography. Results and discussion. At sonography bilious hypertension was established in all 72 (100%) patients. Mechanical jaundice was present in 54 (96.4%) patients. Hepatic dysfunction with 84±9.6 mmol/l hyperbilirubinemia and an increase in AST and ALT levels to 1.2±0.9 mmol/l and 1.5±1.1 mmol/l, were verified respectively. At endoscopic retrograde cholangiopancreatography choledocholithiasis was found in 54 (96.4%) patients. Single stones were present in 18 (32.1%) and multiple – in 38 (67.9%) patients. In 52 (92.9%) cases, stones up to 1.5 cm in diameter were removed with a Dormia basket at one time or after mechanical lithotripsy. In 4 (7.1%) patients stones from 1.7 to 2.0 cm could not be removed endoscopically. Choledoch stenting was performed in 12 (21.4%) patients. One-stage transpapillary treatment was carried out in 38 (67.9%) patients, two and three stage treatment – in 14 (25%) cases, and «open» choledocholithotomy – in 4 (7.1%) cases. Conclusion. The program of choledocholithiasis diagnostics with the gradual use of clinical, laboratory, radiological and endoscopic data allows carrying out correct detailing of the cause, level, degree of common bile duct obstruction and the complicated course of the disease in 100% of cases

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Choledocholithiasis: Evaluation, Treatment, and Outcomes

Cited by 56 publications

References 83 publications

Novel Technique for Laparoscopic Common Bile Duct Exploration Using Endovascular Instrumentation

Novel Technique for Laparoscopic Common Bile Duct Exploration Using Endovascular Instrumentation

Successful endoscopic treatment of giant multiple choledocholithiasis using oral transpapillary cholangioscopy and intraductal contact lithotripsy

Gallstone Disease Complicated by Choledocholithiasis: Modern Aspects of Diagnostics

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