Abstract
Gallstones occur in about 20% of the general population, with 20% of gallstone patients also having common bile duct stones. The vast majority of gallstones are cholesterol stones, which form when bile becomes supersaturated with cholesterol. Up to half of common duct stones are asymptomatic. The most common clinical syndromes due to gallstones include biliary colic, jaundice, cholangitis, and gallstone pancreatitis. These latter two vary in severity and can be life-threatening. Preoperative evaluation takes into account patient symptoms, physical exam, and laboratory and imaging studies. Common duct stones may be detected using ultrasound, computed tomography, magnetic resonance cholangiopancreatography, or biliary scintigraphy. These modalities differ in their efficacies, and each has advantages and disadvantages that should guide their use.
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References
Internal Clinical Guidelines Team (UK). Gallstone disease: diagnosis and management of cholelithiasis, cholecystitis and choledocholithiasis. London: Natl Inst Health Care Excellence (UK). 2014;20(37):13382–401.
Goljan EF, editor. Pathology. Philadelphia: Mosby; 2010.
Tiderington E, Lee SP, Ko CW. Gallstones: new insights into an old story. F1000Res. 2016;5:1817.
Maringhini A, Ciambra M, Baccelliere P, Raimondo M, Orland A, Tine F, Grasso R, Randazzo MA, Barresi L, Gullo D, Musico M, Pagliaro L. Biliary sludge and gallstones in pregnancy: incidence, risk factors, and natural history. Ann Intern Med. 1993;119(2):116–20.
Lammert F, Gurusamy K, Ko CW, Miquel JF, Méndez-Sánchez N, Portincasa P, van Erpecum KJ, van Laarhoven CJ, Wang DQ. Gallstones. Nat Rev Dis Primers. 2016;2:16024.
Katsika D, Grjibovski A, Einarsson C, Lammert F, Lichtenstein P, Marschall HU. Genetic and environmental influences on symptomatic gallstone disease: a Swedish study of 43,141 twin pairs. Hepatology. 2005;41(5):1138–43.
Collins C, Maguire D, Ireland A, Fitzgerald E, O’Sullivan GC. A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg. 2004;239(1):28–33.
Besselink MG, Venneman NG, Go PM, Broeders IA, Siersema PD, Gooszen HG, van Erpecum KJ. Is complicated gallstone disease preceded by biliary colic? J Gastrointest Surg. 2009;13(2):312–7.
Kathpalia P, Ahn J. Assessment of jaundice in the hospitalized patient. Clin Liver Dis. 2015;19:155–70.
Zimmer V, Lammert F. Acute bacterial cholangitis. Viszeralmedizin. 2015;31(3):166–72.
Attasaranya S, Fogel EL, Lehman GA. Choledocholithiasis, ascending cholangitis, and gallstone pancreatitis. Med Clin North Am. 2008;92(4):925–60. x
Demehri FR, Alam HB. Evidence-based management of common gallstone-related emergencies. J Intensive Care Med. 2016;31(1):3–13.
Kimura Y, Takada T, Strasberg SM, Pitt HA, Gouma DJ, Garden OJ, et al. TG13 current terminology, etiology, and epidemiology of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20(1):8–23.
Kimura Y, Takada T, Kawarada Y, Nimura Y, Hirata K, Sekimoto M, et al. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo guidelines. J Hepato-Biliary-Pancreat Surg. 2007;14(1):15–26.
OrÃa A, Cimmino D, Ocampo C, Silva W, Kohan G, Zandalazini H, et al. Early endoscopic intervention versus early conservative management in patients with acute gallstone pancreatitis and biliopancreatic obstruction. Ann Surg. 2007;245(1):10–7.
Huh CW, Jang SI, Lim BJ, Kim HW, Kim JK, Park JS, et al. Clinicopathological features of choledocholithiasis patients with high aminotransferase levels without cholangitis. Medicine. 2016;95(42):e5176.
Colletti PM, Ralls PW, Lapin SA, Siegel ME, Halls JM. Hepatobiliary imaging in choledocholithiasis: a comparison with ultrasound. Clin Nucl Med. 1986;11(7):482–6.
Epelboym I, Winner M, Allendorf JDJ. MRCP is not a cost-effective strategy in the management of silent common bile duct stones. Gastrointest Surg. 2013;17(5):863–71.
Polistina FA, Frego M, Bisello M, Manzi E, Vardanega A, Perin B. Accuracy of magnetic resonance cholangiography compared to operative endoscopy in detecting biliary stones, a single center experience and review of literature. World J Radiol. 2015;7(4):70–8.
Khalfallah M, Dougaz W, Bedoui R, Bouasker I, Chaker Y, Nouira R, et al. Validation of the Lacaine-Huguier predictive score for choledocholithiasis: prospective study of 380 patients. J Visc Surg. 2012;149(1):e66–72.
Maple JT, Ben-Menachem T, Anderson MA, Appalaneni V, Banerjee S, Cash BD, et al. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc. 2010;71(1):1–9.
Kang J, Paik KH, Lee JC, Kim HW, Lee J, Hwang JH, et al. The Efficacy of clinical predictors for patients with intermediate risk of choledocholithiasis. Digestion. 2016;94(2):100–5.
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Ujiki, M., Hedberg, H.M. (2018). Current Understanding of Choledocholithiasis: Clinical Presentation and Preoperative Evaluation. In: Santos, B., Soper, N. (eds) Choledocholithiasis . Springer, Cham. https://doi.org/10.1007/978-3-319-74503-9_2
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DOI: https://doi.org/10.1007/978-3-319-74503-9_2
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