Epidemiology and disease characteristics of symptomatic choledocholithiasis in Sri Lanka

Silva, Waduthanthri Supun Lakmal De; Pathirana, Aloka; Wijerathne, T.; Gamage, Bawantha; Dassanayake, B. K.; Silva, Mohan Malith De

doi:10.14701/ahbps.2019.23.1.41

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…This chronic hepatobiliary ailment is characterized by irregularities in cholesterol, bilirubin, and bile acid metabolism (1). While cholelithiasis is prevalent, choledocholithiasis impacts roughly up to 20 % of individuals with this condition (5,6).…”

Section: Discussion Discussionmentioning

confidence: 99%

Treatment of Choledocholithiasis with Large Stones Through Biliary Tract Exploration and Instrumentation via a T-Tube

Villegas-Coronado,

Murillo-Espinoza,

Ortiz-Valles

et al. 2023

SGO

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Introduction: Choledocholithiasis, the presence of gallstones within the common bile duct, is a challenging medical condition characterized by disruptions in cholesterol, bilirubin, and bile acid metabolism. Patients with choledocholithiasis present with a spectrum of symptoms, from intermittent upper abdominal pain, nausea, and vomiting to jaundice and more severe complications like pancreatitis.Case report: This case study involves a 63-year-old female who presented at the emergency department with colicky pain, jaundice, and discomfort. An abdominal ultrasound diagnosed choledocholithiasis, leading to an endoscopic retrograde cholangiopancreatography (ERCP). The ERCP procedure was technically challenging, possibly due to the choledocholithiasis of large stones (>1.5 cm). Following the initial ERCP, a follow-up CT scan revealed ongoing bile duct dilation and complications related to the stones, necessitating a second procedure. The reintervention proceeded successfully, and the patient recovered well without complications. Conclusions: While conventional therapies for choledocholithiasis, such as ERCP and surgical exploration, demonstrate remarkable success, the reappearance of common bile duct stones raises apprehensions. The need for reintervention could be attributed to elements like anatomical complexities during the initial treatment and stone characteristics. Elevating the outcomes and diminishing the necessity for re-interventions hinges upon the refinement of patient selection, preoperative evaluations, and the implementation of a multidisciplinary approach.

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Section: Discussion Discussionmentioning

confidence: 99%

Treatment of Choledocholithiasis with Large Stones Through Biliary Tract Exploration and Instrumentation via a T-Tube

Villegas-Coronado,

Murillo-Espinoza,

Ortiz-Valles

et al. 2023

SGO

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“…Indeed, 10–20% of the population have gallbladder stones. Among these patients 10–20% have an associated CBD stone [ 9 , 10 , 11 , 12 ]. Its treatment must include an evacuation of the stones of the CBD and a cholecystectomy.…”

Section: Discussionmentioning

confidence: 99%

Predictors of failure of endoscopic retrograde pancreatocholangiography during common bile duct stones

Mériam

Nakhli

Bellil

et al. 2020

Heliyon

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Introduction: Endoscopic retrograde cholangiopancreatography associated with sphincterotomy and stone extraction with balloon or Dormia basket represents the gold standard for the management of common bile duct stones. The aim of our study were to investigate the predictors of failure of standard endoscopic techniques during the management of common bile duct stones. Methods: A retrospective study including all endoscopic retrograde cholangiopancreatography for common bile duct stones between January 2014 and December 2017 was conducted. First line treatment was based on endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy and balloon or Dormia extraction. Second line endoscopic treatment was based on macrodilatation of Oddi sphincter, mechanical lithotripsy, biliary stent or nasobiliary drain placement. Predictors of failure of standard endoscopic techniques were sought by uni and multivariate analysis (SPSS software, p significant if < 0.05). Results: One hundred eighty one patients (mean age 64 years and sex ratio M/W ¼ 0.4) were included. Main indications for endoscopic retrograde cholangiopancreatography were residual or recurrent lithiasis (67.4%, n ¼ 122). Cholangiography revealed multiple stones in 53 patients with an average size of 12.5mm [3-40]. The success rate of first line treatment was 61.9%. Independent predictors of failure of standard endoscopic techniques (failure of papillary cannulation or stone extraction) according to multivariate analysis were: an age greater than 65 years OR 0.516 [0.272-0.979], an intra-diverticular papilla OR 0.179 [0.035-0.914], a common bile duct diameter greater than 15 mm OR 0.161 [0.068-0.385] and a stenosis of the common bile duct OR 0.068 [0.008-0.605]. The success rate of the second line treatment was 73%. Conclusion: Endoscopic retrograde cholangiopancreatography results in a successful clearance of the common bile duct in almost two-thirds of patients. In case of predictors of failure, alternative techniques can increase this rate.

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Is Endoscopic Retrograde Cholangiopancreatography with Balloon Sweeps a Must in Postcholecystectomy Stent Removal for Choledocholithiasis?

Sasikumar,

Lad,

Ingle

et al. 2024

Journal of Digestive Endoscopy

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Objectives This study aims to evaluate whether stent removal through endoscopic retrograde cholangiopancreatography (ERCP) with balloon sweeps is necessary or whether stent removal by forward-viewing gastroscope without cholangiogram is sufficient. Materials and Methods A prospective, single-center study was conducted from April 2022 to March 2023 for 1 year. Adult patients with choledocholithiasis who underwent common bile duct (CBD) clearance and CBD stenting followed by cholecystectomy were included. Then, they underwent CBD stent removal either by gastroscope directly or by side-viewing endoscopy with balloon sweeps and occlusion cholangiogram. Recurrence of stones and complications after stent removal were studied in both groups. Results Forty-seven patients were enrolled in the final study. A total of 64% of patients (n = 30) underwent CBD stent removal followed by balloon sweeps and cholangiogram, and the remaining 34% (n = 17) patients underwent direct stent removal. Time taken for the procedure was more in the balloon sweeps group compared with the direct stent removal group and was statistically significant. No statistically significant adverse events were seen in both groups. Conclusion Patients who underwent CBD stenting for choledocholithiasis after cholecystectomy can safely undergo stent removal using a gastroscope rather than be subjected again to ERCP. This will significantly reduce the duration, unplanned adverse events, and cost of ERCP.

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Epidemiology and disease characteristics of symptomatic choledocholithiasis in Sri Lanka

Cited by 4 publications

References 19 publications

Treatment of Choledocholithiasis with Large Stones Through Biliary Tract Exploration and Instrumentation via a T-Tube

Treatment of Choledocholithiasis with Large Stones Through Biliary Tract Exploration and Instrumentation via a T-Tube

Predictors of failure of endoscopic retrograde pancreatocholangiography during common bile duct stones

Is Endoscopic Retrograde Cholangiopancreatography with Balloon Sweeps a Must in Postcholecystectomy Stent Removal for Choledocholithiasis?

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