Brown Pigment Stones Research Articles

Gallstones: The thing in itself.

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Bile Microbiota in Patients with Pigment Common Bile Duct Stones

BackgroundCommon bile duct (CBD) stone is one of the most prevalent gastroenterological diseases, but the role played by biliary microbiota in the pathogenesis of CBD stones remains obscure. The aim of this study was to investigate the characteristics of the biliary tract core microbiome and its potential association with the formation of pigment stones.MethodsTwenty-eight patients with biliary obstruction of various causes were enrolled. Thirteen had new-onset pigment CBD stone. Of the remaining 15, four had benign biliary stricture, four had gallbladder cancer, three had pancreatic cancer, 3 had distal CBD cancer, and one had hepatocellular carcinoma. Endoscopic retrograde cholangiopancreatography was used to collect bile samples for DNA extraction, 16S ribosomal RNA gene sequencing, and bile microbiota composition analysis.ResultsProteobacteria (61.7%), Firmicutes (25.1%), Bacteroidetes (5%), Fusobacteria (4.6%), and Actinobacteria (2.6%) were the most dominant phyla in the bile of the 28 study subjects. A comparison between new-onset choledocholithiasis and other causes of biliary obstruction (controls) showed Enterococcus was found to be significantly abundant in the CBD stone group at the genus level (linear discriminant analysis score = 4.38; P = 0.03). However, no other significant compositional difference was observed.ConclusionThis study demonstrates an abundance of microbiota in bile juice and presents a biliary microbiome composition similar to that of duodenum. The study also shows Enterococcus was significantly abundant in the bile juice of patients with a brown pigment stone than in controls, which suggests Enterococcus may play an important role in the development of pigment stones.

Bacterial Infection in etiology of Pigment Gallstones

Brown pigment stones are an important cause of acute cholangitis in Oriental Cholangiohepatitis. Bacterial infection and the deconjugation of bile by bacterial b-Glucourindase have been implicated as etiological factors in formation of brown pigment stones but controversy exists regarding their primary importance and causal relationship.

Study of Bacterial Aetiogenicity of Pigment Gall Stones by Culture of Nidus of Calculus and correlation between Stone Culture and Bile Culture

Background: Calculus disease of biliary tract is a major public health problem in north Kashmir and pigment gall stones form a significant portion of gall stones in our region. In this study we prospectively studied 84 cases of pigment gall stones to examine the role of bacteria in the formation of these stones.
 Objective: To study the bacterial aetiology of pigment gall stones.
 Methods: A hospital based prospective study of 84 consecutive cases of pigment gall stones was done from December 2012 to November 2019 and the results of stone culture and bile culture were statistically analysed. Informed consent was obtained from all the patients in the study group.
 Results: A total of 84 cases studied included 32 (38.09%) male patients and 52(61.91%) females patients. The median age was 48.5 years and mean age was 46.2 years. Of 84 patients, 21(25.00%) had black pigment stones and 63 (75.00%) had brown pigment stones. 61 (72.62%) patients presented with biliary colic and 24(28.57%) patients had chronic cholecystitis . Bile culture was positive in 46 (54.76%) patients and stone culture was positive in 70(83.33%) patients.
 Conlusion: A strong association was observed between stone culture and bile culture results (showing similar beta-glucronidase producing bacteria) and pigment stone formation.

Treatment Options for Patients with Gallstones (Cholelithiasis)

According to the Recommendations of the Scientific society of gastroenterologists of Russia for the diagnosis and treatment of cholelithiasis (GI), GI is a multifactorial disease of the hepatobiliary system and one of the most common diseases of the digestive system. It is known that in the vast majority of cases, GI develops as a result of the complex influence of many risk factors. Thus, the change in the qualitative and quantitative composition of bile, as well as a history of gastrectomy, papillosphincterotomy, the right-hand hemicolectomy, cholesterosis gall bladder, chronic hepatitis, peptic ulcer of the duodenum, duodenostasis contributes to the reduction of the contractile function of the gallbladder and the development of hypertonicity of the sphincter of Oddi. Current understanding of mechanisms of formation of gallstones is based on many studies, which proved that the GSD is a result of destabilized bile-damaged hepatocytes, the subsequent nucleation of crystals of monohydrate of cholesterol crystallization in the mucin matrix on the background of hypomotor dysfunction of the gall bladder. After anamnesis and General clinical examination, the main diagnostic method for suspected gastrointestinal tract is ultrasound (ultrasound). However, differentiation of stone types by ultrasound is generally not possible. The most modern diagnostic method is CT with an assessment of the density of stones on the Hounsfield scale. Today, it is common to distinguish three main types of gallstones found in humans: cholesterol, black and brown pigment stones. Methods of treatment of gastrointestinal tract can be divided into invasive or surgical, minimally invasive and non-invasive. Recommending a patient with gastrointestinal surgery, you should always remember that surgical treatment is the elimination of the consequences of cholelithiasis, and not the treatment of its essence. So, after the successful application of udhc in the early 80-ies of the last century for the dissolution of gallstones, drug litholysis, opened a new era in the treatment of gastrointestinal tract and reduced the amount of indications for surgical treatment.

Combined microstructural and mineralogical phase characterization of gallstones in a patient-based study in SW Spain - Implications for environmental contamination in their formation

This study explores the environmental impact of metal exposure on humans through detailed phase and structural characterization of gallstones from two environmentally contrasting populations in Huelva Province (SW Spain). A total of 42 gallstone samples, obtained after surgical intervention at the Riotinto Hospital, were studied by powder X-ray diffraction (XRD), Fourier Transformed Infra-Red spectroscopy (FTIR), FTIR-μ-ATR (Attenuated Total Reflection) coupled with an optical microscope, and by Environmental Scanning Electron Microscope with Energy Dispersive X-ray Spectroscopy (ESEM-EDS), and subsequently classified according to their phase composition and structure. Additionally, the patients were enquired for their living habits in order to analyze the source of possible exposure to metal contamination.The gallstones were classified into pure, mixed and composite cholesterol stones, black and brown pigment stones, and carbonate stones. The patients from the study group residing in a region with acknowledged metal contamination of both natural and anthropogenic origin have a higher risk of metal exposure through contaminated soil, particle matter in the air, and consumption of local water and food products. According to our findings, the metal exposure is related to a higher tendency of forming black pigment stones in the study group in comparison to the control group residing in a natural park with nearly pristine environmental conditions. Moreover, the gallstones from the study group showed to contain more abundant metal components, such as Cu, Fe, Ni, and Zn, than those from the control group. To our knowledge this is the first study to examine the regional environmental impact of metal exposure on human gallstones.

Gallstones.

Gallstones grow inside the gallbladder or biliary tract. These stones can be asymptomatic or symptomatic; only gallstones with symptoms or complications are defined as gallstone disease. Based on their composition, gallstones are classified into cholesterol gallstones, which represent the predominant entity, and bilirubin ('pigment') stones. Black pigment stones can be caused by chronic haemolysis; brown pigment stones typically develop in obstructed and infected bile ducts. For treatment, localization of the gallstones in the biliary tract is more relevant than composition. Overall, up to 20% of adults develop gallstones and >20% of those develop symptoms or complications. Risk factors for gallstones are female sex, age, pregnancy, physical inactivity, obesity and overnutrition. Factors involved in metabolic syndrome increase the risk of developing gallstones and form the basis of primary prevention by lifestyle changes. Common mutations in the hepatic cholesterol transporter ABCG8 confer most of the genetic risk of developing gallstones, which accounts for ∼25% of the total risk. Diagnosis is mainly based on clinical symptoms, abdominal ultrasonography and liver biochemistry tests. Symptoms often precede the onset of the three common and potentially life-threatening complications of gallstones (acute cholecystitis, acute cholangitis and biliary pancreatitis). Although our knowledge on the genetics and pathophysiology of gallstones has expanded recently, current treatment algorithms remain predominantly invasive and are based on surgery. Hence, our future efforts should focus on novel preventive strategies to overcome the onset of gallstones in at-risk patients in particular, but also in the population in general.

Biliary ascariasis in the etiology of recurrent pyogenic cholangitis in an endemic area

Aims: The role of biliary ascariasis in etiology of recurrent pyogenic cholangitis in endemic areas has not been well studied. Methods: We studied 30 patients of recurrent pyogenic cholangitis with brown pigment stones and 30 patients with cholesterol gallstones. Stones from 22 patients (11 brown pigment stones and 11 gallstones) were examined by infrared spectrophotometry to substantiate the classification of stones done on visual inspection. Biliary calculi were considered to be associated with Ascaris lumbricoides in those with: previous documented evidence of biliary ascariasis, bile specimens containing ova of Ascaris lumbricoides on light microscopy and worms, worm fragments or their ova forming the nidus of stones on histological examination. Results: Bile cultures grew microorganisms in 24 (80%) patients with recurrent pyogenic cholangitis while only one patient with gallstones grew Escherichia coli from bile. None of the patients in either group had past or persisting evidence of clonorchiasis. Five patients had previous documentation of biliary ascariasis. In three patients bile contained ova of Ascaris lumbricoides and stones in 22 patients contained worm, worm fragments or their ova on histological examination. Overall 24 (80%) patients with recurrent pyogenic cholangitis had past or persistent evidence of biliary ascariasis while only one patient with gallstones had worm fragments on histopathology of stones (p ＜ 0.001). Conclusion: We conclude that in endemic areas bacterial infection of the bile ducts in recurrent pyogenic cholangitis occurs with biliary invasion by Ascaris lumbricoides and dead worms, their fragments or ova form nidus of brown pigment stones formation in such patients.

Application of Electron Paramagnetic Resonance to Study of Gallstones

We present the results of an electron paramagnetic resonance (EPR) study of mixed cholesterol gallstones. We have established that free radicals are distributed nonuniformly within the interior of the stone. The type and number of paramagnetic centers depend on the pigment content in the selected layer. We show that the parameters of the sextet lines in the EPR spectrum of the pigment are close to the parameters of lines in the spectrum of a brown pigment stone.

Late Complications and Stone Recurrence Rates after Bile Duct Stone Removal by Endoscopic Sphincterotomy and Large Balloon Dilation are Similar to Those after Endoscopic Sphincterotomy Alone

Background/AimsBetween endoscopic sphincterotomy (ES) alone and combined endoscopic sphincterotomy and large balloon dilation (ES-LBD) groups, efficacy and long-term complications, difference in biliary stone recurrence rate, and risk factors of stone recurrence were compared.MethodsMedical records of 222 patients who underwent ERCP for biliary stone removal were retrospectively reviewed. Patients with dilated CBD ≥11 mm and follow-up longer than 6 months were included.ResultsThere were 101 patients in ES-LBD group and 121 patients in ES group. Mean follow-up duration was 25.0 (6-48) months and 13.0 (6-43) months, respectively (p=0.001). There was no difference in number of ERCP sessions, brown pigment stones, angle between mid and distal common bile duct (CBD angle) <135°, and lithotripsy rate. Complete retrieval success rate was excellent in both groups (100% vs. 99%). Early complication rate of ES-LBD and ES alone group was 4 and 4.1%, respectively (p=1.000). One patient in ES-LBD group died from delayed bleeding. Late complication rate was 5.9 and 3.3%, respectively (p=1.000). Stone recurrence rate was 6.9% and 5.8%, respectively (p=0.984). The only Independent risk factor of stone recurrence was presence of periampullary diverticulum.ConclusionsLate complication and stone recurrence rates were similar between ES-LBD and ES alone groups.

Gallstones in New Zealand: composition, risk factors and ethnic differences

Gallstone disease is a worldwide problem causing morbidity, mortality and a drain on health-care resources. This prospective study aimed to investigate the spectrum of gallstone types in New Zealand and relate these to known risk factors. Gallstone samples were collected from 107 patients undergoing surgery for gallstone disease at Auckland City Hospital between June 2009 and June 2010. Detailed chemical analyses were performed using Fourier Transform Raman spectroscopy. The relationship between gallstone type and age, gender, ethnicity, obesity and positive family history were analysed. Median age was 51 years (range 19-88), 75 (70%) were female, one third were obese (body mass index ≥ 30) and 41% had a positive family history. Major ethnic groups were European (51%), Asian (23%) and Māori/Pacific (18%). Gallstone types included pure or mixed cholesterol stones (74%), black pigment stones (20%) and brown pigment stones (5%). Asians had a higher proportion of black pigment stones and NZ Europeans had more cholesterol and mixed cholesterol stones (odds ratio 3.6 (95% CI 1.1 to 11.5)). The frequency of cholesterol/mixed cholesterol stones was not significantly different between NZ Europeans and Māori/Pacific groups (P = 0.7). Black pigment stones were more common in older patients (mean 68.0 years compared with 47.6 for cholesterol/mixed cholesterol stones) (P = 0.0001). There was no significant relationship between stone type and family history (P = 0.16) or gender (P = 0.17). This novel prospective study highlights risk factors and ethnic differences in gallstone composition in New Zealand. These may be important when considering gallstone prevention strategies.

Influence of Black and Brown Pigment Stone in Cholecystectomized Patients With Acute Biliary Pancreatitis.

BackgroundBiliary tract stones account for the majority of cases with acute pancreatitis, and include black and brown pigment stones. The aim of the study was to compare the presentation and outcome in cholecystectomized patients with acute biliary pancreatits caused by black and brown pigment stones.MethodData from patients with prior cholecystectomy and acute biliary pancreatitis were collected from January 2009 to August 2011. These cases were assigned to black or brown pigment stone groups according to the stone pattern. The general data, laboratory data, image findings and outcomes of the two groups were collected and analyzed.ResultsA total of 98 enrolled patients, with 30 (30.6%) and 68 cases (69.4%) assigned to the black and brown pigment stone groups, respectively. The cases with black pigment stone had higher CT Severity Index scores, bilirubin, ALP, ALT, rates of cholangitis, and positive blood culture. In those with brown pigment stone, there was a higher number of ERCP evaluations performed.ConclusionCholecystectomized cases with biliary pancreatitis due to black pigment stone had a higher prevalence of laboratory cholestasis and a higher rate of cholangitis.

Color Doppler Twinkling Artifacts from Gallstones: In Vitro Analysis Regarding their Compositions and Architectures

The purpose of our study was to investigate the relationship between a twinkling artifact and the biochemical compositions of gallstones in phantom experiments. Fifty-two gallstones surgically extracted from 26 patients (26 cholesterol, 12 brown pigment and 14 black pigment stones) were included in the phantom study. Color Doppler sonography was performed to evaluate the occurrence of a twinkling artifact behind the stones. The artifacts were graded from grade 0 (no artifact) to grade 3 (very strong artifact). Micro computed tomography (CT) images were obtained to analyze the internal architecture and external surface of the stones. A total of 20 of 26 cholesterol stones (77%) produced grade 2 or 3 artifacts, whereas almost all the black pigment stones and more than half of the brown pigment stones produced no artifacts or grade 1 artifacts ( p = 0.0010). The sensitivity and specificity of grade 2 or greater artifacts for cholesterol stones were 76.9% and 76.9%, respectively. The composition of the stones was strongly correlated with the internal shape on the micro CT image. Cholesterol stones with rough surfaces did not show stronger intensities of the artifacts than those with smooth surfaces ( p > 0.05). In conclusion, most of the prominent artifacts arose from cholesterol stones having radial or radial-concentric internal architectures, whereas the black pigment stones mostly produced little artifact. (E-mail: leejy4u@snu.ac.kr)

The cholangiographic features of severe forms of ABCB4/MDR3 deficiency-associated cholangiopathy in adults

We previously reported the association of ABCB4/MDR3 gene variants with a peculiar form of cholelithiasis in European adults, currently referred to as the LPAC syndrome. ABCB4/MDR3 deficiency is also now thought to be related to some forms of hepatolithiasis in Japan. We herein report in eight patients a new phenotype associated with ABCB4 gene mutations, characterized by a typical LPAC symptomatic disease associated with large uni- or multifocal spindle-shaped dilations of the intrahepatic bile ducts without any bile duct stenosis, and filled of gallstones. We excluded from this series, the patients with minimal intrahepatic bile duct dilations, with bile duct stenosis, with focal or diffuse irregular bile ducts compatible with the diagnosis of sclerosing cholangitis, with bile duct dilations that did not contain stones or alternatively with stones in bile ducts without large dilations. The prevalence of this phenotype does not exceed 5 to 10% of the patients with LPAC syndrome. Importantly, the ABCB4/MDR3 mutations observed in this series did not differ from those observed in patients with LPAC syndrome with no or minimal intrahepatic bile duct dilations that could suggest a specific genetic background in this setting. This variant shows similar sensitivity to ursodeoxycholic acid and may be partly reversible under long-term therapy. In summary, we describe here a peculiar cholangiographic phenotype of the LPAC syndrome characterized by single-shaped large bile duct dilations filled with cholesterol or brown-pigment stones. This phenotype is not associated with a peculiar type of ABCB4 mutation.

Cholesterol, non-cholesterol sterols and bile acids in paediatric gallstones

Depending on underlying aetiopathogenetic factors human gallstones contain various amounts of cholesterol, non-cholesterol sterols and bile acids, which have remained unexplored in paediatric gallstone patients. To evaluate sterol and bile acids compositions of paediatric gallstones. Study group included 21 consecutively cholecystectomised children. Gas-liquid chromatography was used to quantitate gallstone sterols and bile acids. Results were compared to adult gallstones (n=194). Cholesterol stones (n=9) had higher proportions of cholesterol and lathosterol, but lower those of lanosterol and phytosterols than pigment stones (n=12) (p<0.05 for each). Patients with gallstone cholesterol content over 70% were female. Gallstone cholesterol positively reflected body mass index and, in cholesterol stones-group, age (r=approximately +0.700, p<0.05). Three patients on parenteral nutrition had brown pigment stones consisting of high amounts of campesterol and sitosterol ranging 483-9303 microg/100 mg of stone. Pigment stones had 13-fold higher amount of bile acids than cholesterol stones (p<0.05). Black pigment stones contained approximately 3-fold higher phytosterol proportions, and pigment stones and cholesterol stones had approximately 43% lower proportions of deoxycholic acid than adults (p<0.05). Gallstones in patients on parenteral nutrition are rich in phytosterols. With respect to gallstone sterols, gallstone disease of adolescent girls resembles that of adults. Composition of bile acids in paediatric gallstones is different from adults.

Composition of gallbladder and bile duct calculi

The composition of gallbladder and bile duct stones removed at the time of cholecystectomy was analysed in a consecutive series of 45 patients. The type of stones at the two sites was similar in all but two patients. Cholesterol content differed by more than 20% in only six patients. Cholesterol stones were found in the gallbladder of 33 patients, in the bile duct of 36 patients (73 and 80%, respectively); mixed stones in eight and five patients, respectively (18 and 11%); brown-pigment stones in three patients each (7%); black-pigment stones in one patient each (2%). Bile duct stones overlooked during cholecystectomy are thus suitable for litholysis, e.g. by irrigation with monooctanoin, in the majority of cases.

The multiple facets of ABCB4 (MDR3) deficiency

ABCB4 (MDR3), a lipid translocator, moves phosphatidylcholine from the inner to the outer leaflet of the canalicular membrane. Genetic mutations of ABCB4 lead to three distinct but related hepatobiliary diseases. Progressive familial intrahepatic cholestasis (PFIC) type 3 is a chronic cholestatic syndrome characterized by a markedly elevated gamma-glutamyltranspeptidase. Patients present with jaundice, pruritus, and hepatosplenomegaly. Periportal inflammation progresses to biliary cirrhosis and causes portal hypertension. Ursodeoxycholic acid (UDCA) normalizes liver function tests in approximately one half of treated PFIC type 3 patients. Partial responders or nonresponders eventually will require liver transplantation. Gallstone patients with ABCB4 mutations may have low phospholipid-associated cholelithiasis syndrome, characterized by cholesterol gallstones and intrahepatic microlithiasis, along with recurrent biliary symptoms, despite cholecystectomy. Patients with ABCB4 mutations also may develop intrahepatic brown pigment stones. UDCA may improve biliary symptoms even before the dissolution of stones occurs. Additional therapies such as farnesoid X receptor ligands/agonists and benzfibrates show future therapeutic promise. Intrahepatic cholestasis of pregnancy affects pregnant women with abnormal ABCB4. These women suffer from disabling pruritus and also may experience steatorrhea. Fetuses are at high risk for prematurity and stillbirths. The definitive treatment is delivery of the baby. In the interim, limited fat intake, fat-soluble vitamin supplementation, and UDCA with or without S-adenosylmethionine can provide symptomatic relief. Additional hepatobiliary diseases related to ABCB4 mutations are likely to be identified. This may result in the discovery of additional therapies for PFIC type 3, gallstones, and intrahepatic cholestasis of pregnancy.

Calcium carbonate gallstones in children

Background In the United States, cholesterol stones account for 70% to 95% of adult gallstones and black pigment stones for most of the remainder. Calcium carbonate stones are exceptionally rare. A previous analysis of a small number of pediatric gallstones from the north of England showed a remarkably high prevalence of calcium carbonate stones. The aims of this study were to analyze a much larger series of pediatric gallstones from our region and to compare their chemical composition with a series of adult gallstones from the same geographic area. Methods A consecutive series of gallbladder stones from 63 children and 50 adults from the north of England were analyzed in detail using Fourier transform infrared microspectroscopy. Demographic and clinical data were collected on all patients. The relative proportions of each major stone component were assessed: cholesterol, protein and calcium salts of bilirubin, fatty acids, calcium carbonate, and hydroxyapatite. Results Thirty-nine (78%) adults had typical cholesterol stones, 7 (14%) had black pigment bilirubinate stones, and only 2 (4%) had calcium carbonate stones. In contrast, 30 (48%) children had black pigment stones, 13 (21%) had cholesterol stones, 15 (24%) had calcium carbonate stones, 3 (5%) had protein dominant stones, and 2 (3%) had brown pigment stones. In children, cholesterol stones were more likely in overweight adolescent girls with a family history of gallstones, whereas black pigment stones were equally common in boys and girls and associated with hemolysis, parenteral nutrition, and neonatal abdominal surgery. Calcium carbonate stones were more common in boys, and almost half had undergone neonatal abdominal surgery and/or required neonatal intensive care. Conclusion The composition of pediatric gallstones differs significantly from that found in adults. In particular, one quarter of the children in this series had calcium carbonate stones, previously considered rare. Geographic differences are not the major reason for the high prevalence of calcium carbonate gallstones in children.

Diagnosis of intrahepatic and common duct stones: Combined unenhanced and contrast-enhanced helical CT in 1090 patients

We determined the accuracy of combined unenhanced and contrast-enhanced helical computed tomography (CT) for diagnosis of bile duct stones. During a 12-month period, 1090 patients who underwent combined CT and endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic cholangioscopy (PTC) were enrolled in this study. The results of prospective CT interpretation regarding the presence of bile duct stones were compared with results of endoscopic stone removal, PTC and with surgical results. In 70 patients, detectability of stones on CT was evaluated depending on stone types. Of 1090 study patients, 175 and 299 patients were confirmed to have intrahepatic and common duct stones, respectively. The sensitivity and specificity of combined CT were 73% and 98% for diagnosis of intrahepatic stones and 71% and 97% for common duct stones. Of 70 patients 24, 25, and 21 patients had cholesterol, black pigment, and brown pigment stones, respectively. Eleven of 24 cholesterol stones, 21 of 25 black pigment stones, and 15 of 21 brown pigment stones were detected on combined CT. Combined CT is of limited sensitivity for detection of bile duct stones, especially in Western countries where cholesterol stones predominate. It may be of greater value in populations with a higher incidence of pigment stones. Other complementary imaging modalities are needed for patients with negative CT findings who are highly suspected to have biliary stones.

Incidence of Juxtapapillary Duodenal Diverticula Is Higher in Brown Pigment Stone But Not in Black Pigment Or Cholesterol Stone

Background and Aims: Juxtapapillary duodenal diverticula (JDD) is acquired lesion found more often in older patients. Several studies have suggested association between JDD and bile duct stones. In this study, we wanted to know the incidence of JDD and its association with various bile duct stones together with the success and complication rates of endoscopic retrograde cholangiopancreatography (ERCP) in JDD patients. Materials and Methods: 527 consecutive patients(296 male, 231 female; mean age 63.4 years) having ERCP for various causes were enrolled from January 2004 to November 2005. The ERCP records were retrospectively analyzed. The patients were subdivided into two groups: non-JDD group (n = 398) and JDD group (n = 129). The ERCP procedure related factors and relation with the stones were analyzed. Stones were divided on the basis of their gross morphology and cross-sectional appearance into cholesterol, black pigment, brown pigment stones. Results: JDD was present in 129/527 patients (24.6%). Patients with JDD were more frequently encountered in elderly group and having cholangitis more frequently. The presence of JDD was more common in common bile duct stones {103/129 (79.8%), 193/398 (48.5%), respectively, p = 0.000}, but not in gallbladder stones {44/129 (34.1%), 110/398 (27.6%), respectively, p = 0.170}. Considering the types of bile duct stones, the presence of JDD correlated with brown pigment stones {60/129 (46.5%), 49/398 (12.3%), respectively, p = 0.000}, not black pigment {29/129 (22.5%), 82/398 (20.6%), respectively, p = 0.659} or cholesterol stones {7/129 (5.4%), 39/398 (9.8%), respectively, p = 0.123}. There were no significant differences between two groups in terms of successful cannulation (94.5% vs 96.9%) and stone extraction (92.6% vs 95.6%). The incidence of post ERCP pancreatits was similar in both groups (16.1% vs 18.9%), but bleeding after sphinterotomy was higher in JDD group {26/127 (20.4%), 42/383 (10.9%), respectively, p = 0.017}. Conclusions: JDD is associated with an increased incidence of common bile duct stones especially with brown pigment stones but not with cholesterol or black pigment stones. JDD did not cause technical difficulty at ERCP but appears to be a risk factor for bleedings of endoscopic sphicterotomy.