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

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.

A Nomogram for Predicting the Risk of Common Bile Duct Stones Based on Preoperative Laboratory Tests and Ultrasonography 

“…In this study, we used the univariate and multivariate logistic regression analysis to determine the predictive factors for CBD stone. Our results revealed that multiple gallbladder stones, the maximal diameter of CBD stone measured by preoperative ultrasonography, preoperative GGT level and DB/TB ratio were independent predictors of CBD stone, which had been reported by previous studies [17][18][19]. * US, Ultrasonography; US Positive indicates that imaging examination revealed CBD stone; CBDD, the value of maximal CBD dimeter measured on the Ultrasonography; ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALP, alkaline phosphatase; GGT, glutamyl transpeptidase; TB, total bilirubin; DB, direct bilirubin; HR, hazard ratio; CI, confidence interval; P-value<0.05 indicates statistical significance.…”

The influence of stone size on spontaneous passage of common bile duct stones in patients with acute cholangitis: A retrospective cohort study

“…The overall incidence of spontaneous passage CBD stones in prior studies was between 21 and 73% [ [9] , [10] , [11] , [12] , [13] , [14] ]. Tranter et al [ 9 ] found that spontaneous passage of CBD stones occurred more commonly in patients with pancreatitis, biliary colic, and cholecystitis.…”

“…Additionally, we generated ROC curve analysis for size of stone and found that stone size of less than 4.85 mm was more likely to pass spontaneously with acceptable sensitivity (81.8%) and specificity (78.9%). However, Khoury et al [ 11 ] found a stone larger than 3.5 mm had low chance to pass spontaneously with acceptable sensitivity (71%) and specificity (69%).…”

“…Nevertheless, the authors found the spontaneous passage of common bile duct stones in some patients with acute cholangitis. Few previous studies reported 21–73% of patients with previous or current evidence of ductal stones passed their stones spontaneously [ [9] , [10] , [11] , [12] , [13] , [14] ] and the stones have passed naturally when clinical symptoms improved and hematological parameters returned to normal [ 10 ]. Other studies found that intrahepatic bile duct dilatation, stone diameter, and distal bile duct stones were radiological predictors of stone passage [ 11 ] and stones less than 5 mm in diameter were more likely to spontaneously passed [ 12 ].…”

A rolling stone: vomiting of a gallstone without the presence of a biliary-enteric fistula

“…Gallstones may pass into the GI tract spontaneously through the common bile duct, particularly if the stone size is <3.5 mm [ 6 ]. However, a stone can also pass through a biliary-enteric fistula, a complication seen in 0.3–1.5% of all patients with cholelithiasis [ 7 ].…”