Bile duct stones (BDS) are usually secondary to gallstones but may be found primarily in biliary system, although the percentage is minimal. They are usually suspected on history and clinical examination alone but symptoms may be variable ranging from asymptomatic to complications such as biliary colic, pancreatitis, jaundice or cholangitis, the latter can be life-threatening in some patients. Abnormalities in the liver function tests especially the elevated direct bilirubin and alkaline phosphatase indirectly raise the suspicion. The majority of BDS can be diagnosed by Transabdominal Ultrasound, but in some cases further imaging such as, Computed Tomography, Endoscopic Ultrasound or Magnetic Resonance Cholangiography are employed prior to endoscopic or laparoscopic removal. Approximately 90% of BDS can be removed following Endoscopic Retrograde Cholangiography (ERC) + sphincterotomy. Most of the remaining stones can be removed using mechanical lithotripsy. Patients with uncorrected coagulopathies may be treated with ERC + pneumatic dilatation of the sphincter of Oddi. Shockwave lithotripsy (intraductal and extracorporeal) and laser lithotripsy have also been used to fragment large bile duct stones prior to endoscopic removal. Despite all the minimally invasive procedures the role of open surgery for the removal of difficult or impacted stones cannot be completely forgotten. The role of medical therapy in treatment of BDS is currently uncertain. This review focuses on the clinical presentation, investigation and current management of BDS.
| Published in | Biomedical Sciences (Volume 6, Issue 4) |
| DOI | 10.11648/j.bs.20200604.15 |
| Page(s) | 102-110 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2020. Published by Science Publishing Group |
Bile Duct Stones (BDS), Endoscopic Retrograde Cholangiopancreatography (ERCP), Common Bile Duct (CBD), Intra-operative Cholangiography (IOC)
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APA Style
Inamullah, Syed Muhammad Ali, Burhan Khan, Fakhar Shahid, Zia Aftab, et al. (2020). Management of Common Bile Duct Stones: A Comprehensive Review. Biomedical Sciences, 6(4), 102-110. https://doi.org/10.11648/j.bs.20200604.15
ACS Style
Inamullah; Syed Muhammad Ali; Burhan Khan; Fakhar Shahid; Zia Aftab, et al. Management of Common Bile Duct Stones: A Comprehensive Review. Biomed. Sci. 2020, 6(4), 102-110. doi: 10.11648/j.bs.20200604.15
AMA Style
Inamullah, Syed Muhammad Ali, Burhan Khan, Fakhar Shahid, Zia Aftab, et al. Management of Common Bile Duct Stones: A Comprehensive Review. Biomed Sci. 2020;6(4):102-110. doi: 10.11648/j.bs.20200604.15
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author = {Inamullah and Syed Muhammad Ali and Burhan Khan and Fakhar Shahid and Zia Aftab and Mohannad Al-Tarakji and Ejaz Latif and Ahmed Zarour},
title = {Management of Common Bile Duct Stones: A Comprehensive Review},
journal = {Biomedical Sciences},
volume = {6},
number = {4},
pages = {102-110},
doi = {10.11648/j.bs.20200604.15},
url = {https://doi.org/10.11648/j.bs.20200604.15},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.bs.20200604.15},
abstract = {Bile duct stones (BDS) are usually secondary to gallstones but may be found primarily in biliary system, although the percentage is minimal. They are usually suspected on history and clinical examination alone but symptoms may be variable ranging from asymptomatic to complications such as biliary colic, pancreatitis, jaundice or cholangitis, the latter can be life-threatening in some patients. Abnormalities in the liver function tests especially the elevated direct bilirubin and alkaline phosphatase indirectly raise the suspicion. The majority of BDS can be diagnosed by Transabdominal Ultrasound, but in some cases further imaging such as, Computed Tomography, Endoscopic Ultrasound or Magnetic Resonance Cholangiography are employed prior to endoscopic or laparoscopic removal. Approximately 90% of BDS can be removed following Endoscopic Retrograde Cholangiography (ERC) + sphincterotomy. Most of the remaining stones can be removed using mechanical lithotripsy. Patients with uncorrected coagulopathies may be treated with ERC + pneumatic dilatation of the sphincter of Oddi. Shockwave lithotripsy (intraductal and extracorporeal) and laser lithotripsy have also been used to fragment large bile duct stones prior to endoscopic removal. Despite all the minimally invasive procedures the role of open surgery for the removal of difficult or impacted stones cannot be completely forgotten. The role of medical therapy in treatment of BDS is currently uncertain. This review focuses on the clinical presentation, investigation and current management of BDS.},
year = {2020}
}
TY - JOUR T1 - Management of Common Bile Duct Stones: A Comprehensive Review AU - Inamullah AU - Syed Muhammad Ali AU - Burhan Khan AU - Fakhar Shahid AU - Zia Aftab AU - Mohannad Al-Tarakji AU - Ejaz Latif AU - Ahmed Zarour Y1 - 2020/12/16 PY - 2020 N1 - https://doi.org/10.11648/j.bs.20200604.15 DO - 10.11648/j.bs.20200604.15 T2 - Biomedical Sciences JF - Biomedical Sciences JO - Biomedical Sciences SP - 102 EP - 110 PB - Science Publishing Group SN - 2575-3932 UR - https://doi.org/10.11648/j.bs.20200604.15 AB - Bile duct stones (BDS) are usually secondary to gallstones but may be found primarily in biliary system, although the percentage is minimal. They are usually suspected on history and clinical examination alone but symptoms may be variable ranging from asymptomatic to complications such as biliary colic, pancreatitis, jaundice or cholangitis, the latter can be life-threatening in some patients. Abnormalities in the liver function tests especially the elevated direct bilirubin and alkaline phosphatase indirectly raise the suspicion. The majority of BDS can be diagnosed by Transabdominal Ultrasound, but in some cases further imaging such as, Computed Tomography, Endoscopic Ultrasound or Magnetic Resonance Cholangiography are employed prior to endoscopic or laparoscopic removal. Approximately 90% of BDS can be removed following Endoscopic Retrograde Cholangiography (ERC) + sphincterotomy. Most of the remaining stones can be removed using mechanical lithotripsy. Patients with uncorrected coagulopathies may be treated with ERC + pneumatic dilatation of the sphincter of Oddi. Shockwave lithotripsy (intraductal and extracorporeal) and laser lithotripsy have also been used to fragment large bile duct stones prior to endoscopic removal. Despite all the minimally invasive procedures the role of open surgery for the removal of difficult or impacted stones cannot be completely forgotten. The role of medical therapy in treatment of BDS is currently uncertain. This review focuses on the clinical presentation, investigation and current management of BDS. VL - 6 IS - 4 ER -
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