Factors related to the spontaneous passage of common bile duct stones through the papilla: a single-center retrospective cohort study

Abstract

Objective Common bile duct (CBD) stones can spontaneously pass through the papilla. This study explored factors associated with stone passage by comparing differences in the clinical features of stones retained in the CBD and excreted stones. Methods Data were retrospectively collected for all patients who were hospitalized in our center between March 2016 and May 2021 with clinical, laboratory, or imaging evidence of CBD stones. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and were classified into two groups: group A (stones extracted by ERCP, n = 86) and group B (stones discharged before ERCP, n = 15). Demographic data, biochemical and radiological findings were compared between the groups. Results Stone size (0.82 vs. 0.33 cm), and levels of total bilirubin (58.2 vs. 28.8 μmol/L), gamma-glutamyl transpeptidase (416.7 vs. 193.9 U/L), alkaline phosphatase (191.9 vs. 123.1 U/L), carbohydrate antigen 19-9 (603.7 vs. 37.2 U/mL), and α-L-fucosidase (37.4 vs. 22.6 U/L) were significantly higher in group A than in group B. Logistic regression analyses showed that stone size was the only factor significantly associated with spontaneous passage of CBD stones. Conclusions CBD stones less than 0.33 cm in size may be self-expelled through the papilla.

Can inflammatory indexes predict the spontaneous passage of common bile duct stones?

“…It is clear that there is a possibility of spontaneous migration in at least 20% of the stones, but different spontaneous migration rates may have been reported depending on the retrospective nature of the studies and likely due to the differences in the study designs. 2,3,[7][8][9] As predicted, small stones, especially those <5 mm in size, have a higher likelihood of spontaneous passage. 2,3,[7][8][9] While the average stone size was 6 mm in the group that stones were detected in the ERCPs, the average stone size was 3 mm in the group without stones, and our findings support the claim that the smaller the stone size, the greater the likelihood of spontaneous migration.…”

“…1 Before ERCP, there is a need for additional methods to be applied per patient where clinical and laboratory data are analyzed. 2,3,[7][8][9] A spontaneous stone passage was detected in 27.2% of the study's cases. In the study by Reid et al, 10 the rate of cases in which stones were detected on MRCP but undetected on ERCP was 24.57%.…”

“…2,3 One-fifth to one-third of the stones were reported to discharge spontaneously, and smaller stones are more prone to migration. [7][8][9] Since unnecessary ERCP procedures frequently associate with high rates of complications, the exact indications are imperative to avoid post-ERCP complications. 1 Before ERCP, there is a need for additional methods to be applied per patient where clinical and laboratory data are analyzed.…”

“…2 It is recognized that the probability of finding stones on ERCP increases with the size of the CBD diameter, and our results support this. 8 Such a result may be attributed to the presence of multiple and larger diameters in patients with stones detected on ERCP.…”

“…1 Before ERCP, there is a need for additional methods to be applied per patient where clinical and laboratory data are analyzed. 2,3,7–9…”