Nonprocedural Management of Common Bile Duct Stones

Abstract

The standard of care for the management of biliary stones is via endoscopy. Alternatives exist to endoscopic or surgical intervention, especially in patients who have a high risk of procedural complications. While the non-procedural management of biliary stones is feasible with medications such as ursodeoxycholic acid and statins, these therapies are not the standards of care with many factors influencing the effectiveness of complete bile stone dissolution.

Keywords

Common bile duct stones Endoscopic retrograde cholangiopancreatography (ERCP) Bile salts Chenodeoxycholic acid (CDCA) Ursodeoxycholic acid (UDCA) Statins Ezetimibe 

References

  1. 1.
    Barrett KE. Chapter 11: Bile formation and secretion. In: Gastrointestinal physiology. New York, NY: Lange Medical/McGraw-Hill, Medical Pub. Division; 2006.Google Scholar
  2. 2.
    Reshetnyak VI. Physiological and molecular biochemical mechanisms of bile formation. World J Gastroenterol. 2013;19(42):7341–60.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Barrett KE. Chapter 16: Lipid assimilation. In: Gastrointestinal physiology. New York, NY: Lange Medical/McGraw-Hill, Medical Pub. Division; 2006.Google Scholar
  4. 4.
    Wang DQH, Cohen DE, Carey MC. Biliary lipids and cholesterol gallstone disease. J Lipid Res. 2009;50(Suppl):S406–11.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Trotman BW, Soloway RD. Pigment vs cholesterol cholelithiasis: clinical and epidemiological aspects. Am J Dig Dis. 1975;20(8):735–40.PubMedCrossRefGoogle Scholar
  6. 6.
    Carey MC, Small DM. The physical chemistry of cholesterol solubility in bile. Relationship to gallstone formation and dissolution in man. J Clin Invest. 1978;61(4):998–1026.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Einarsson C, Hillebrant CG, Axelson M. Effects of treatment with deoxycholic acid and chenodeoxycholic acid on the hepatic synthesis of cholesterol and bile acids in healthy subjects. Hepatology. 2001;33(5):1189–93.PubMedCrossRefGoogle Scholar
  8. 8.
    Danzinger RG, Hofmann AF, Schoenfield LJ, Thistle JL. Dissolution of cholesterol gallstones by chenodeoxycholic acid. N Engl J Med. 1972;286:1–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Tint GS, Salen G, Colalillo A, et al. Ursodeoxycholic acid: a safe and effective agent for dissolving cholesterol gallstones. Ann Intern Med. 1982;97(3):351–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Tuncer I, Harman M, Colak Y, Arslan I, Turkdogan MK. Effect of ursodeoxycholic acid alone and ursodeoxycholic acid plus domperidone on radiolucent gallstones and gallbladder contractility in humans. Gastroenterol Res Pract. 2012;2012:1–6.CrossRefGoogle Scholar
  11. 11.
    Petroni ML, Jazrawi RP, Pazzi P, et al. Ursodeoxycholic acid alone or with chenodeoxycholic acid for dissolution of cholesterol gallstones: a randomized multicentre trial. The British-Italian Gallstone Study group. Aliment Pharmacol Ther. 2001;15(1):123–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Villanova N, Bazzoli F, Taroni F, et al. Gallstone recurrence after successful oral bile acid treatment. A 12-year follow-up study and evaluation of long-term postdissolution treatment. Gastroenterology. 1989;97(3):726–31.PubMedGoogle Scholar
  13. 13.
    Chapman BA, Burt MJ, Chisholm RJ, Allan RB, Yeo KH, Ross AG. Dissolution of gallstones with simvastatin, an HMG CoA reductase inhibitor. Dig Dis Sci. 1998;43(2):349–53.PubMedCrossRefGoogle Scholar
  14. 14.
    Wilson IR, Hurrell MA, Pattinson NR, Chapman BA. The effect of simvastatin and bezafibrate on bile composition and gall-bladder emptying in female non-insulin-dependent diabetics. J Gastroenterol Hepatol. 1994;9(5):447–51.PubMedCrossRefGoogle Scholar
  15. 15.
    Tazuma S, Kajiyama G, Mizuno T, et al. A combination therapy with simvastatin and ursodeoxycholic acid is more effective for cholesterol gallstone dissolution than is ursodeoxycholic acid monotherapy. J Clin Gastroenterol. 1998;26(4):287–91.PubMedCrossRefGoogle Scholar
  16. 16.
    Pulkkinen J, Eskelinen M, Kiviniemi V, et al. Effect of statin use on outcome of symptomatic cholelithiasis: a case-control study. BMC Gastroenterol. 2014;14:119.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Ahmed MH. Ezetimbe as potential treatment for cholesterol gallstones: the need for clinical trials. World J Gastroenterol. 2010;16(13):1555–7.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Wang HH, Portincasa P, Mendez-sanchez N, Uribe M, Wang DQ. Effect of ezetimibe on the prevention and dissolution of cholesterol gallstones. Gastroenterology. 2008;134(7):2101–10.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal MedicineThe Ohio State University Wexner Medical CenterColumbusUSA
  2. 2.Department of Internal MedicineThe Ohio State University Wexner Medical CenterColumbusUSA

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