Should we redefine large common bile duct stone?

Sharma, Shyam Sunder; Jain, P. A.

doi:10.3748/wjg.14.651

Cited by 17 publications

(18 citation statements)

References 5 publications

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“…Strictures below a stone may also affect the ability to extract these CBD stones. Some authors have suggested that any definition of a large CBD stone should include a relation to the lower CBD diameter to enable a relative comparison . Hence, we would like to propose a definition of large CBD stone as >15 mm with a stone to CBD ratio of >1.0 …”

Section: Nomenclature and Definitionmentioning

confidence: 99%

Current endoscopic strategies for managing large bile duct stones

Doshi

Yasuda

Ryozawa

et al. 2018

Digestive Endoscopy

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Common bile duct stones are a relatively common occurrence and can often lead to devastating complications. Endoscopic retrograde cholangiopancreatography was introduced in the 1970s for management of common bile duct stones. Most common bile duct stones can be removed with simple techniques such as endoscopic sphincterotomy and balloon trawling. However, large bile duct stones continue to pose some difficulty in achieving complete extraction. In this article, we will review some of the established techniques such as the use of endoscopic papillary large balloon dilatation, mechanical lithotripsy, and cholangioscopy-assisted techniques. We will look at the recent literature to help clarify the particular methods and answer some of the questions surrounding these methods.

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Section: Nomenclature and Definitionmentioning

confidence: 99%

Current endoscopic strategies for managing large bile duct stones

Doshi

Yasuda

Ryozawa

et al. 2018

Digestive Endoscopy

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“…Other predictors have been cited in the litt erature: a papilla localized in the bulb or in the 3rd portion CBD: common bile duct. of the duodenum [1,5], a surgical reconstruction (Billroth II or Y-branch of Roux) [1,19,24] and a cuboid or barrel form of the stones [25,26]. The predictors of failure of CBD clearance found in the literature are summarized in Table 5.…”

Section: Discussionmentioning

confidence: 99%

“…There is no consensus in the literature to define a large stone: most authors use a cut-off between 10 and 15mm [ 20 , 24 ]. Sharma et al recommend including the diameter of the CBD to define a large calculus and thus speaking of a large stone if the size of the stone is greater than the diameter of the CBD by more than 2 mm (ratio of the stone size/diameter of CBD> 1) [ 24 ]. This ratio (stone size/diameter of the CBD >1) was found as a predictor of failure in multivariate analysis [ 1 ].…”

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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“…However, some biliary stones may become a challenge, depending on their location, number and especially dimensions. While there is no consensus regarding the definition of complexity criteria, difficulties may arise due to local and anatomical conditions such as strictures, diverticula, disproportion between the size of distal bile duct and the stone (difference greater than 2 mm), post – surgical altered anatomy and multiple (10 or more) or large stones (with a diameter of ≥ 15 mm) 1 8 10 11 12 13 .…”

Section: Introductionmentioning

confidence: 99%

Complex biliary stones management: cholangioscopy versus papillary large balloon dilation – a randomized controlled trial

et al. 2018

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Background and study aims Endoscopic removal of biliary stones has high success rates, ranging between 85 % to 95 %. Nevertheless, some stones may be challenging and different endoscopic methods have evolved. Papillary large balloon dilation after sphincterotomy is a widely used technique with success rates ranging from 68 to 90 % for stones larger than 15 mm. Cholangioscopy allows performing lithotripsy under direct biliary visualization, either by laser or electrohydraulic waves, which have similar success rate (80 % – 90 %). However, there is no study comparing these 2 techniques. Patients and methods From April 2014 to June 2016, 100 patients were enrolled and randomized in 2 groups, using a non-inferiority hypothesis: cholangioscopy + electrohydraulic lithotripsy (group 1) and endoscopic papillary large balloon dilation (group 2). The main outcome was complete stone removal. Adverse events were documented. Mechanical lithotripsy was not performed. Failure cases had a second session with crossover of the methods. Results The mean age was 56 years. 74 (75.5 %) patients were female. The initial overall complete stone removal rate was 74.5 % (77.1 % in group 1 and 72 % in group 2, P > 0.05). After second session the overall success rate achieved 90.1 %. Procedure time was significantly lower in group 2, – 25.2 min (CI95 % – 12.48 to – 37.91). There were no significant differences regarding technical success rate, radiologic exposure and adverse events. Conclusion Single-operator cholangioscopy-guided lithotripsy and papillary large balloon dilation are effective and safe approaches for removing complex biliary stones.

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Should we redefine large common bile duct stone?

Cited by 17 publications

References 5 publications

Current endoscopic strategies for managing large bile duct stones

Current endoscopic strategies for managing large bile duct stones

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

Complex biliary stones management: cholangioscopy versus papillary large balloon dilation – a randomized controlled trial

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