Etiology, Pathogenesis and Therapy of Pigment Gallstones

Leuschner, U.; Güldütuna, S.; Hellstern, A

doi:10.1159/000171312

Cited by 6 publications

(4 citation statements)

References 25 publications

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“…Risk factors for cholesterol stone formation include hyperlipidemia, female gender, total parenteral nutrition and others. Pigment stones include black stones, associated with hemolysis and liver cirrhosis, and brown stones (the most common type of CBDS) which are associated with recurrent bile duct infection [ 10 , 11 , 18 ]. Pigmented stones, mainly the brown type, are the most common type of primary recurrent CBDS.…”

Section: Risk Factors For Recurrent Cbdsmentioning

confidence: 99%

“…While cholesterol stones are the most common gallstones (75-80%), recurrent CBDS are usually pigment stones, mainly brown stones, associated with recurrent biliary infections [ 10 , 11 ]. The hypothesis behind this association is that, following ERCP and endoscopic sphincterotomy, a laxity of the sphincter of Oddi develops, and this in turn causes backward flow of duodenal contents into the biliary and pancreatic ducts, and thus, recurrent infections with stone formation.…”

Section: Introductionmentioning

confidence: 99%

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Primary Recurrent Common Bile Duct Stones: Timing of Surgical Intervention

2022

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Cholelithiasis (gallstones) is a very common medical problem worldwide, with 5-30% of patients demonstrating a combined condition of cholelithiasis and choledocholithiasis (common bile duct stones (CBDS)). CBDS are usually classified as primary or secondary stones. Primary CBDS are defined as stones detected 2 years or more following cholecystectomy, while secondary stones, the most common type, usually migrate from the gallbladder to the bile ducts. Recurrent CBDS are defined as stones detected 6 months or more following endoscopic retrograde cholangiopancreatography (ERCP) with complete duct clearance. Although ERCP with endoscopic sphincterotomy has emerged as the main therapeutic option for CBDS, with up to 95% bile duct clearance rate, up to 25% of said patients develop recurrent bile duct stones. Thus far, several issues related to recurrent CBDS are still unclear and questions regarding this specific pathology have no precise answers: how many trials of ERCP and endoscopic sphincterotomy should be attempted before referring the patient for surgical management? Is there an association between risk factors and early surgical intervention? Thus, currently, there is no worldwide scientific-based consensus regarding the best management of this specific group of patients. The main issue for this article is to review the relevant English literature and find out the main high risk factors for recurrent CBDS, and form a diagnostic and treatment plan, hence, identifying the subgroup of patients that will benefit from early surgical management, preventing further ERCP-associated complications.

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Section: Risk Factors For Recurrent Cbdsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Primary Recurrent Common Bile Duct Stones: Timing of Surgical Intervention

2022

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“…In our patient, a black pigment stone was found in the common bile duct. The formation of pigment stones is increased in patients with hemolytic disorders, bile duct injuries, bacterial infections of bile ducts, and in patients with cirrhosis (19). Black stones are composed primarily of calcium salts of unconjugated bilirubin carbonate and phosphate.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Biliary Sphincterotomy and Stone Extraction in a Child with Choledocholithiasis Complicating Byler's Disease

Braegger,

Altorfer

1996

J. pediatr. gastroenterol. nutr.

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“…Black pigment gallstones are associated with typical hyperbilirubinbilia factors such as hemolysis, liver cirrhosis, and pathologic enterohepatic cycling of unconjugated bilirubin. Brown pigment gallstones are associated with biliary infection (10)(11)(12). Recurrent bile duct stones mostly belong to pigment gallstones.…”

Section: Introductionmentioning

confidence: 99%