Relationship between cystic duct diameter and the presence of cholelithiasis

Abstract

We sought to measure cystic duct diameter in patients without biliary calculi and in those with cholelithiasis or choledocholithiasis. Using endoscopic retrograde cholangiopancreatography (ERCP), we visualized the cystic duct in 168 patients referred to our unit. These patients were distributed into three groups based on findings at ERCP: Group I (N = 57), no calculi in the gallbladder or common bile duct; group II (N = 27), stones found in the gallbladder but absent from the common bile duct; and group III (N = 34), stones present in the common bile duct with or without gallbladder stones. The diameter of the cystic duct was measured at its widest and narrowest dimensions. The largest diameter measured was greater in group III (7.72 +/- 2.29 mm) than in groups I (2.63 +/- 0.67 mm) and II (4.59 +/- 1.13 mm) (P < 0.001). The same differences were found in measurement of the smallest diameter (5.00 +/- 0.99 mm, 3.10 +/- 0.62 mm, and 1.83 +/- 0.53 mm, for groups III, II, and I, respectively) (P < 0.001). Maximal and minimal cystic duct diameter show a progressive increase at each level of disease. This increase in cystic duct size may facilitate the migration of gallstone fragments after lithotripsy and facilitate the instrumentation of the cystic duct during ERCP and laparoscopic cholecystectomy.

The flow of bile in the human cystic duct

“…The pathophysiological functions of cystic duct and its contribution to the genesis of cholelithiasis have been discussed extensively over the years (Lichtenstein and Ivy, 1937;Scott and Otto, 1979;Otto et al, 1979;Pitt et al, 1981Pitt et al, ,1982Doty et al, 1983;and Sharp et al, 1990). Recent investigations have pointed out that cholelithiasis is related to abnormal cystic duct configurations (Bornman et al, 1988;Shaw et al, 1993;Kubota et al, 1993;Castelain et al, 1993;Caroli-Bosc et al, 1997;Deenitchin et al, 1998). In particular, Deenitchin et al (1998) showed that, statistically, subjects with gallstones had longer or narrower cystic ducts than those without.…”

Investigation of the functional three-dimensional anatomy of the human cystic duct: A single helix?

“…Castelain et al (1993) found that increasing diameter of the duct correlated with increasing severity of gallstone disease, possibly as a result of migration of small stones from the gallbladder causing distension in the duct. Patients without stones had the smallest diameter ducts, followed by those with stones only in the gallbladder.…”

Cystic duct and Heister's “valves”

“…For example, a low, left-sided entry of the CD into the BD is associated with gallstone disease (Bornman et al, 1988;Caroli-Bosc et al, 1997). In adults, Castelain et al (1993) failed to show an association between a narrow CD and cholelithiasis but Deenitchin et al (1998) found that a longer and narrower CD and a more acute angle between the gallbladder and CD was strongly correlated with the presence of gallstones. Congenital stenosis of the CD has been implicated as an etiologic factor in children (Forshall and Rickham, 1954).…”

“…It conveys bile to and from the gall bladder. In adults, the CD has a variable length (5-90 mm) and luminal diameter (2.6 Ϯ 0.7 mm) (Lichtenstein and Ivy, 1937;Castelain et al, 1993) but it is typically 2-4 cm long. Its course is frequently tortuous.…”