The influence of stone size on spontaneous passage of common bile duct stones in patients with acute cholangitis: A retrospective cohort study

Abstract

Background The common bile duct (CBD) stones passage in patients with cholangitis was unclear. This study aimed to evaluate the effect on CBD stone sizes and predicting factors on spontaneous passage in patients with cholangitis. Method The medical records of cholangitis at Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University from January 2014 to December 2019 were retrospectively reviewed. Patients with acute cholangitis from CBD stones underwent ERCP in the same admission were enrolled. Result Of the 96 patients, The rate of spontaneous passage of CBD stones was 19.8%. By univariate analysis, factors significantly associated with a predictor of spontaneous CBD stone passage in patient with cholangitis were single CBD stone (p = 0.001), CBD stone diameter < 5 mm (p < 0.001), and clinical symptom improved before ERCP procedure (p = 0.004). Multivariate logistic regression analyses also revealed that these three factors were significantly associated with spontaneous passage. From ROC curve analysis, stone size of less than 4.85 mm was more likely to pass spontaneously with acceptable sensitivity (81.8%) and specificity (78.9%). Conclusions CBD stone diameter < 5 mm, single CBD stone and improved clinical symptom before ERCP procedure are key predictors of spontaneous CBD stone passage in cholangitis.

Invalidity of Tokyo guidelines in acute biliary pancreatitis: A multicenter cohort analysis of 944 pancreatitis cases

“…[24][25][26][27] The low stone retention rate is probably due to the observation that AP is elicited by smaller bile stones (median of 3 mm in the study by Tranter et al) or sludge. 22,23,25,28 this is significantly less than what was observed in the retained stone groups in the same cohorts. This means that with detected bile duct dilatation (or even a detected smaller stone that will come to pass without intervention), the criteria for AC can also be easily fulfilled in biliary AP without the de facto presence of the diagnosed condition.…”

“…The low stone retention rate is probably due to the observation that AP is elicited by smaller bile stones (median of 3 mm in the study by Tranter et al.) or sludge 22,23,25,28 . Nevertheless, even a transient obstruction can lead to mucosal edema and bile duct dilation: despite the considerably smaller stone size in spontaneous passage patient groups, biliary dilatation is often present—a mean CBD diameter of 8.5 ± 3.8 mm was found on admission in the study by Khoury et al.…”

The liberal use of magnetic resonance cholangiopancreatography can be switched over to its selective use to detect choledocholithiasis

“…1,2 Choledocholithiasis may be silent or at times pass spontaneously in 19% of cases especially related to cholangitis but most of the times it is associated with major morbidity and mortality due to complications like cholangitis and acute pancreatitis; hence its detection and timely management is of utmost importance. 3 The choledocholithiasis is suspected based on clinical findings (biliary colic, jaundice, cholangitis, and acute pancreatitis), abnormal liver function tests (raised bilirubin, and elevated alkaline phosphatase) and/or imaging findings on abdominal ultrasonography. 4,5 Magnetic resonance cholangiopancreatography (MRCP) has demonstrated sensitivity of 85-95% and specificity of 90-100% for detection of common bile duct stones.…”

Reporte de Caso Clínico: Migración de cálculo dificultoso

“…Algunos cálculos coledocianos, preoperatoriamente, pueden pasar espontáneamente por la papila hacia el duodeno antes de la cirugía o CPRE y por lo tanto no se observan en la colangiografia intraoperatoria (CIO). Esta situación, que llamamos migración de litiasis coledociana, parecería ser más probable en algunas situaciones como; cuando existe mejoría de los síntomas antes de la intervención, cuando el diámetro del lito es menor a 5 mm, o el cálculo es único [3,4]. La migración de litiasis puede causar dolor abdominal; en algunos casos puede ser causa de pancreatitis.…”

“…No obstante, la migración asintomática de cálculos mayores a 1 cm (macrolitiasis) es atípica. [4][5][6][7][8]. A continuación, presentamos un caso de migración de un macrocálculo ubicado en colédoco medio y su revisión bibliográfica.…”