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Restoration of common bile duct diameter within 2 weeks after endoscopic stone retraction is a preventive factor for stone recurrence

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Hepatobiliary & Pancreatic Diseases International 2018年第3期17卷 251-256页

作者： Jin Jeon Sung Uk Lim Chang-Hwan Park Chung-Hwan Jun Seon-Young Park Jong-Sun Rew Department of Internal Medicine Chonnam National University Hospital Department of Internal Medicine Mokpo Hankook Hospital

Background： Little information is available about the relationship between restoration of common bileduct （CBD） diameter after endoscopic stone retraction and recurrence of CBD stones in elderly patients.The present study was to determine whether restoration of CBD diameter is a preventive factor for CBDstone recurrence in elderly patients who underwent endoscopic retrograde cholangiopancreatography（ERCP）.

关键词： Restoration common bile duct Endoscopic retrograde cholangiopancreatography common bile duct stone

Removal of intrahepatic bile duct stone could reduce the risk of cholangiocarcinoma

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World Journal of Clinical Cases 2024年第11期12卷 1881-1884页

作者： Gowthami Sai Kogilathota Jagirdhar Yatinder Bains Salim Surani Department of Medicine Saint Francis Health Science CenterNewarkNJ 07107United States Department of Gastroenteroly Saint Michaels Medical CenterNewarkNJ 07102United States Department of Medicine and Pharmacology Texas A&M UniversityCollege StationTX 77843United States

Hepatolithiasis(HL)poses a significant risk for cholangiocarcinoma(CCA)development,with reported incidences ranging from 5%-13%.Risk factors include older age,smoking,hepatitis B infection,and prolonged HL duration.Chronic inflammation and mechanical stress on the biliary epithelium contribute to CCA pathogenesis.Hepatectomy reduces CCA risk by removing stones and atrophic liver segments.However,residual stones and incomplete removal increase CCA risk.Kim et al identified carbohydrate antigen 19-9,carcinoembryonic antigen,and stone laterality as CCA risk factors,reaffirming the importance of complete stone removal.Nonetheless,challenges remain in preventing CCA recurrence post-surgery.Longer-term studies are needed to elucidate CCA risk factors further.

关键词： Hepatolithiasis Cholangiocarcinoma Biliary stone common bile duct stone Cholangitis

Surgical strategies for challenging common bile duct stones in the endoscopic era: A comprehensive review of current evidence

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World Journal of Gastrointestinal Endoscopy 2024年第6期16卷 305-317页

作者： Tharathorn Suwatthanarak Vitoon Chinswangwatanakul Asada Methasate Chainarong Phalanusitthepha Minoru Tanabe Keiichi Akita Thawatchai Akaraviputh Minimally Invasive Surgery Unit Department of SurgeryFaculty of Medicine Siriraj HospitalMahidol UniversityBangkok Noi 10700BangkokThailand Graduate School of Medical and Dental Sciences Tokyo Medical and Dental UniversityBunkyo 113-8519TokyoJapan Department of Hepatobiliary and Pancreatic Surgery Tokyo Medical and Dental UniversityBunkyo 113-8519TokyoJapan Department of Clinical Anatomy Tokyo Medical and Dental UniversityBunkyo 113-8519TokyoJapan

While endoscopic retrograde cholangiopancreatography(ERCP)remains the primary treatment modality for common bile duct stones(CBDS)or choledocho-lithiasis due to advancements in instruments,surgical intervention,known as common bile duct exploration(CBDE),is still necessary in cases of difficult CBDS,failed endoscopic treatment,or altered anatomy.Recent evidence also supports CBDE in patients requesting single-step cholecystectomy and bile duct stone removal with comparable outcomes.This review elucidates relevant clinical anatomy,selection indications,and outcomes to enhance surgical understanding.The selection between trans-cystic(TC)vs trans-choledochal(TD)approaches is described,along with stone removal techniques and ductal closure.Detailed surgical techniques and strategies for both the TC and TD approaches,including instrument selection,is also provided.Additionally,this review comprehensively addresses operation-specific complications such as bile leakage,stricture,and entrapment,and focuses on preventive measures and treatment strategies.This review aims to optimize the management of CBDS through laparoscopic CBDE,with the goal of improving patient outcomes and minimizing risks.

关键词： Choledocholithiasis common bile duct stone Difficult common bile duct stone common bile duct exploration Laparoscopic common bile duct exploration

Gastrointestinal microbiome and cholelithiasis:Current status and perspectives

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World Journal of Gastroenterology 2023年第10期29卷 1589-1601页

作者： Wan-Yue Dan Yun-Sheng Yang Li-Hua Peng Gang Sun Zi-Kai Wang Microbiota Division Department of Gastroenterology and HepatologyThe First Medical CenterChinese PLA General HospitalBeijing 100853China Medical School Nankai UniversityTianjin 300071China

Cholelithiasis is a common digestive disease affecting 10%to 15%of adults.It imposes significant global health and financial burdens.However,the pathogenesis of cholelithiasis involves several factors and is incompletely elucidated.In addition to genetic predisposition and hepatic hypersecretion,the pathogenesis of cholelithiasis might involve the gastrointestinal(GI)microbiome,consisting of microorganisms and their metabolites.High-throughput sequencing studies have elucidated the role of bile,gallstones,and the fecal microbiome in cholelithiasis,associating microbiota dysbiosis with gallstone formation.The GI microbiome may drive cholelithogenesis by regulating bile acid metabolism and related signaling pathways.This review examines the literature implicating the GI microbiome in cholelithiasis,specifically gallbladder stones,choledocholithiasis,and asymptomatic gallstones.We also discuss alterations of the GI microbiome and its influence on cholelithogenesis.

关键词： Gallstone Cholesterol gallstone common bile duct stone bile acid bile microbiome Gastrointestinal microbiome

Sequential therapy for patients with cirrhosis complicated by common bile duct stones and moderate to severe gastroesophageal varices

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Chinese Medical Journal 2012年第23期125卷 4312-4314页

作者： HUANG Liu-ye ZHANG Bo CUI Jun LIU Yun-xiang WU Cheng-rong LIN Shu-juan Department of Gastroenterology Yantai Yuhuangding HospitalYantaiShandong 264000China

Cirrhosis complicated by common bile duct stones is a common clinical finding.1 Currently, good therapeutic results occur in patients with cirrhosis complicated by moderate to severe gastroesophageal varices and common bile duct stones using endoscopic variceal ligation （EVL） and/or embolization followed two weeks later by calculus removal with endoscopic retrograde cholangiopancreatography （ERCP）.

关键词： cirrhosis common bile duct stone gastroesophageal varices endoscopic retrograde cholangiopancreatography endoscopic variceal ligation embolization

Self-expandable metal stents for choledocholithiasis in Billroth II gastrectomy patients

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Hepatobiliary & Pancreatic Diseases International 2018年第6期17卷 546-552页

作者： Min-Gui Han Eunae Cho Chang-Hwan Park Chung-Hwan Jun Seon-Young Park Division of Gastroenterology Department of Internal MedicineChonnam National University Hospital42Jaebong-roDong-KuGwangju 61482Korea

Background: Efficient ampullary intervention is essential for endoscopic retrograde cholangiopancreatography(ERCP) in patients with a prior Billroth II gastrectomy. We retrospectively evaluated the safety and effectiveness of ampullary intervention using fully covered self-expandable metal stents(FCSEMSs) for the management of common bile duct(CBD) stones in a subset of patients with a history of Billroth II gastrectomy. Methods: This retrospective analysis involved patients with a prior Billroth II gastrectomy who underwent ampullary intervention with FCSEMSs for the management of CBD stones. The factors associated with FCSEMSs placement, treatment success, and procedural complications were analyzed. Results: A group of 15 patients(10 males; median age, 78 years) underwent biliary metal stent placement for high degree of CBD angulation(6), small or flat papilla with unclear margin(5), current use of double antiplatelet agents or an anticoagulant(2), unwanted instrumentation of the cystic duct(1), and insecure position of the scope(1). Ampullary intervention with FCSEMSs was successful in all patients. After dilating the ampulla of Vater and building a durable conduit with FCSEMSs immediately, CBD stones were removed successfully from all patients in a single session. A mild post-ERCP pancreatitis occurred in one patient, who recovered without complications. Conclusion: Ampullary intervention with FCSEMSs is safe and effective for the management of CBD stones in a subset of patients with a history of Billroth II gastrectomy.

关键词： common bile duct stone Endoscopic retrograde cholangiopancreatography Stent placement stone extraction

Risk factors of choledocholithiasis formation after liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2013年第2期12卷 215-217页

作者： Zhi-Yong Yu Min Zhang Yun-Sheng Qin Xiao-Ping Zhou Ming-Yue Cai Song-Feng Yu Qing-Hong Ke Shu-Sen Zheng Division of Hepatobiliary and Pancreatic Surgery Key Laboratory of Combined Multi-organ Transplantation Ministry of Public Health and Key Laboratory of Organ Transplantation Zhejiang Province First Affiliated Hospital Zhejiang University School of Medicine

Systematic study of risk factors for biliary stone post-liver transplantation is rarely performed. To investigate the risk factor of choledocholithiasis formation after liver transplantation, we c onducted a case-control study. Fourteen patients were selected into a study group. The stones of the bile duct of the patients were confirmed and treated successfully by endoscopic retrograde cholangiopancreatography. For univariate analysis, we selected carefully some potential risk factors such as cold ischemia time, warm ischemia time, and biliary stricture. The results revealed that cold ischemia time and biliary stenosis were significant predictors. But multivariate analysis revealed that only biliary stenosis was a significant risk factor. In conclusion, biliary stenosis is a risk factor of bile duct stones formation after liver transplantation. Endoscopic retrograde cholangiopancreatography is effective and safe in the diagnosis or treatment of bile duct stones after liver transplantation.

关键词： liver transplantation endoscopic retrograde cholangiopancreatography choledocholithiasis biliary tract diseases common bile duct stone gallstones

Mechanical lithotripsy and/or stenting in management of difficult common bile duct stones

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Hepatobiliary & Pancreatic Diseases International 2009年第5期8卷 524-528页

作者： Adem Akcakaya Orhan Veli Ozkan Gurhan Bas Atilla Karakelleoglu Orhan Kocaman Ismail Okan Mustafa Sahin First Department of General Surgery Vakif Gureba Training and Research Hospital34280 IstanbulTurkey Faculty of Medicine Department of General SurgeryMustafa Kemal University 31100 HatayTurkey Faculty of Medicine Department of GastroenterologyKocaeli University41760 KocaeliTurkey

BACKGROUND:Mechanical lithotripsy and/or stent insertion is the alternative therapeutic approach in difficult endoscopic retrograde cholangiopancreatography (ERCP)case.This study was designed to investigate the appropriate treatment for extraction of bile duct stones in difficult cases of ERCP. METHODS:Between 2000 and 2008,744 ERCP procedures were performed in 592 patients with choledocholithiasis in our endoscopy unit.The demographic features,and clinical and laboratory findings were collected from a prospectively held database.bile duct calculi were extracted by basket and/or balloon catheter following ERCP and sphincterotomy.Patients with retained stones were regarded as difficult cases.These patients were treated with mechanical lithotripsy and those with incomplete clearance of stones underwent stent placement. RESULTS:Two hundred and forty-five patients(41%) were male and 347(59%)were female with a mean age of 58 years(range 19-95 years).stones were impacted in 27 patients(5%).stone extraction was performed by basket and/or balloon catheter in 610 ERCP procedures,and lithotripsy was performed in 70 ERCP procedures.Forty- four patients underwent stent insertion,and 20 underwent stent replacement.Morbidity occurred in 39 patients (5%),with no mortality associated with the procedure.Hemorrhage occurred in 9 patients and basket impaction in 4.Mild pancreatitis and cholangitis developed in 12 and 11 patients,respectively. CONCLUSION:Difficult cases of bile duct stones can be treated successfully with lithotripsy,and a stent should be applied when the common bile duct cannot be cleared completely.

关键词： common bile duct stone endoscopic retrograde cholangiopancreatography stone extraction mechanical lithotripsy stenting

Complications of common bile duct stones: A risk factors analysis

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Hepatobiliary & Pancreatic Diseases International 2021年第4期20卷 361-365页

作者： Dong Jun Oh Ji Hyung Nam Dong Kee Jang Jun Kyu Lee Department of Internal Medicine Dongguk University Ilsan HospitalGoyang 10326Korea

Background: The latest guidelines recommended that common bile duct stones(CBDSs) should be removed, preferably endoscopically, regardless of the presence of symptoms or complications. However, the removal of CBDSs may not be feasible in very old patients or those with co-morbidities. In these cases, it is important to understand the risk factors for the development of CBDSs-related complications to decide whether or not to treat high-risk patients. Herein, we aimed to identify the risk factors for the development of complications after the diagnosis of CBDSs. Methods: The medical records of patients with CBDSs between October 2005 and September 2019 were retrospectively analyzed. All patients with radiologically-diagnosed CBDSs, including those who received treatment and those who did not, were analyzed. Results: A total of 634 patients were included and 95(15.0%) patients had CBDS-related complications during the mean follow-up period of 32.6 months. Forty-four(6.9%) high-risk patients remained asymptomatic and did not receive treatment during the follow-up period. In multivariate analyses, size of CBDSs ≥ 5 mm and no treatment within 30 days were independent risk factors for the development of complications. The spontaneous passage of CBDSs was proved radiologically in 9 out of 81(11.1%) patients within 30 days. Conclusions: It is recommended treating CBDSs within 30 days from the diagnosis, even in high-risk patients, especially if the size is larger than 5 mm.

关键词： common bile duct stone Risk factors Obstructive jaundice Pancreatitis Cholangitis