Common Bile Duct Stones: Health Care Problem and Incidence

Abstract

Choledocholithiasis, or common bile duct (CBD) stones, are a common problem in the USA and Westernized cultures. Complications of choledocholithiasis can be serious, including biliary obstruction, gallstone pancreatitis, and cholangitis. The burden of the spectrum of diseases related to stones within the biliary tree is significant. Fortunately, with advances in diagnostic and therapeutic modalities, the mortality from these complications has declined over the past three decades. The gallbladder is the source of the majority of CBD stones in Westernized cultures. These are secondary stones, composed primarily of cholesterol. Populations at higher risk of gallstone formation (and therefore at risk of developing secondary CBD stones) including Native Americans, Mexican Americans, women, elderly patients, obese patients, those with certain chronic diseases (cirrhosis, cystic fibrosis, Sickle cell disease), patients experiencing rapid weight loss (bariatric surgery patients) and critically ill patients receiving total parenteral nutrition (TPN). Primary stones occur with greater prevalence in Southeast Asian populations. These stones, called brown stones, have a higher bilirubin content than cholesterol stones and are frequently infected. Retained stones are a subtype of secondary stones left in the biliary tree after cholecystectomy. Many retained stones pass spontaneously and are asymptomatic, though a proportion of patients with retained stones go on to develop CBD stone complications with signs and symptoms similar to patients with secondary CBD stones.