Parameters Suggesting Spontaneous Passage of Stones from Common Bile Duct: A Retrospective Study.

Tawfik Khoury,Rifaat Safadi,Wisam Sbeit,Samir Abu-Gazaleh,Muhamad Massarwa,Yosef Azraq,Ashraf Imam,Abed Khalaileh,Ari Benson,Avital Bilitzky-Kopit,Zaher Bahouth,Mohamed Adileh

doi:10.1155/2019/5382708

Abstract

Background Common bile duct (CBD) stones are common. However, they are known to pass spontaneously, which obviates the need for ERCP. Aim The aim of this study is to identify specific predictors for spontaneous passage of CBD stones. Methods Data was retrospectively collected for all patients who were hospitalized with clinical, laboratory, or ultrasonographic evidence of choledocholithiasis and who underwent magnetic resonance cholangiopancreatography (MRCP) in Hadassah Medical Center between 2005 and 2011. The patients were classified into 4 groups: group A (positive MRCP and positive ERCP), group B (positive MRCP but negative ERCP), group C (positive MRCP but did not undergo ERCP), and group D (negative MRCP that did not undergo ERCP) for choledocholithiasis. All positive MRCP-groups (A+B+C) were further grouped together into group E. We compared groups A versus B and groups E versus D. Results Comparing groups A versus B, only gamma-glutamyl transferase predicted spontaneous passage of stones from CBD, as the level was significantly higher in group A (677±12.1) versus group B (362.4±216.2) (P=0.023). Patients with small stone diameter (P=0.001), distal stones (P=0.05), and absence of intrahepatic dilatation (P=0.047) tend to pass their stones spontaneously. Comparing groups D versus E, it was found that male gender (P=0.03), older age (P<0.001), high levels of GGT (P=0.022), high levels of alkaline phosphatase (P=0.011), high levels of total bilirubin (P=0.007), and lower levels of amylase (P<0.001) are predictors for positive MRCP studies for CBD stones. Conclusion Identification of specific predictors is important to avoid unnecessary invasive endoscopic intervention.

Highlights

Gallstone disease is a commonly encountered disease worldwide
We compared characteristics of patients who had a positive magnetic resonance cholangiopancreatography (MRCP) and subsequent positive endoscopic retrograde cholangiopancreatography (ERCP) to those of patients with a positive MRCP and subsequent negative ERCP and we compared patients with a positive MRCP with those who had a negative MRCP. These comparisons allowed us to identify factors related to spontaneous passage of Common bile duct (CBD) stones either from the time of MRCP until ERCP or from the time of the initial suspension of CBD stones until MRCP performance
The results of our study revealed that advanced age was a risk factor for failure of spontaneous passage of CBD stones

Summary

Introduction

Gallstone disease is a commonly encountered disease worldwide. The incidence increases with age and females are twice as likely to be affected as compared to male patients [1]. Magnetic resonance cholangiopancreatography (MRCP) has emerged and replaced ERCP for diagnosis of CBD stones as it identifies up to 91% of biliary stones, but still stones smaller than 5 mm were detected only in 71% of cases [7]. In some patients diagnosed with CBD stones on MRCP, the subsequent ERCP does not detect CBD stones These findings suggest that the CBD stones had probably passed. Common bile duct (CBD) stones are common They are known to pass spontaneously, which obviates the need for ERCP. Comparing groups D versus E, it was found that male gender (P=0.03), older age (P

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