From the Guidelines
Approximately 10-20% of patients with pancreatic disease have common bile duct stones, as estimated in individuals with symptomatic gallstones. This association is particularly relevant in patients with acute biliary pancreatitis, where gallstones migrate from the gallbladder into the common bile duct, potentially causing obstruction at the ampulla of Vater. The presence of these stones can exacerbate pancreatic inflammation by blocking pancreatic enzyme outflow and causing reflux of bile into the pancreatic duct, as noted in the management of common bile duct stones 1.
The relationship between pancreatic disease and common bile duct stones works both ways, as pancreatic inflammation can also affect bile duct function and promote stone formation. Patients with chronic pancreatitis may develop stones due to altered bile composition and flow dynamics. Diagnosis typically involves imaging studies such as MRCP, endoscopic ultrasound, or ERCP, with the latter also serving as a therapeutic option for stone removal, as discussed in the radiologic management of biliary obstruction 1.
Key points to consider in the management of common bile duct stones in patients with pancreatic disease include:
- Early identification and removal of common bile duct stones to prevent complications like cholangitis, worsening pancreatitis, or biliary obstruction
- The use of endoscopic retrograde cholangiopancreatography (ERCP) as a therapeutic option for stone removal, which has become the mainstay of treatment for choledocholithiasis
- The importance of individual clinical judgement in the care of adult patients with suspected or proven common bile duct stones, as highlighted in the updated guideline on the management of common bile duct stones 1.
From the Research
Prevalence of Common Bile Duct Stones in Pancreatic Disease
- The prevalence of common bile duct stones in patients with pancreatic disease is not directly stated in the provided studies.
- However, study 2 reports that common bile duct obstruction is found in 3.2-45.6% of patients with chronic pancreatitis, and common duct stones may develop in some of these patients.
- Study 3 mentions that the incidence of biliary stricture and duodenal obstruction in hospitalized patients with pancreatitis is about 6% and 1.2%, respectively, but does not provide a specific percentage for common bile duct stones.
- Study 4 discusses the management of biliary acute pancreatitis, but does not provide information on the prevalence of common bile duct stones in patients with pancreatic disease.
- Study 5 focuses on the identification of biliary origin in acute pancreatitis, but does not provide data on the prevalence of common bile duct stones.
- Study 6 reports on the use of extracorporeal shock wave lithotripsy for pancreatic and large common bile duct stones, but does not provide information on the prevalence of common bile duct stones in patients with pancreatic disease.
Associated Conditions and Complications
- Common bile duct obstruction and stones can be associated with chronic pancreatitis, biliary cirrhosis, cholangitis, and other complications 2, 3.
- The presence of gallstones is a common cause of acute pancreatitis, and the management of biliary acute pancreatitis varies according to its severity 4, 5.
- Extracorporeal shock wave lithotripsy can be an effective treatment for large pancreatic and common bile duct stones 6.