From the Guidelines
To prevent the formation of Choledocholithiasis, avoiding unnecessary endoscopic retrograde cholangiography (ERCP) is crucial, as it can increase the risk of acute pancreatitis, a well-recognized complication of ERCP 1.
Key Factors to Avoid
- Unnecessary ERCP procedures: ERCP should be reserved for patients with proven bile duct stones, diagnosed through low-risk modalities such as ultrasound, endoscopic ultrasound, or magnetic resonance cholangiopancreatography (MRCP) 1.
- Pancreatic duct cannulation or contrast-filling: These procedures should be avoided during ERCP for common bile duct stones (CBDS) whenever possible, as they can increase the risk of post-ERCP pancreatitis (PEP) 1.
- Failed attempts at stent placement: Repeated attempts at stent placement can dramatically increase the risk of PEP, emphasizing the need for endoscopists to be properly trained in this technique 1.
Additional Considerations
- Prophylactic NSAIDs: The use of rectal NSAIDs, such as 100 mg indomethacin or diclofenac, can reduce the risk of PEP in patients undergoing ERCP 1.
- Short-term pancreatic duct stenting: This procedure can reduce the risk of PEP in patients at increased risk of this complication, but its additive benefit with universal use of rectal NSAIDs is uncertain 1.
From the Research
Factors to Avoid in Preventing Choledocholithiasis
To prevent the formation of Choledocholithiasis (gallstones in the common bile duct), several factors should be avoided, including:
- Biliary obstruction, which can lead to the formation of stones in the common bile duct 2, 3
- Inflammation, which can increase the risk of recurrence of choledocholithiasis 4
- Bacteria, which can contribute to the formation of stones in the common bile duct 4
- Certain congenital factors, such as abnormalities in the biliary tree, which can increase the risk of developing choledocholithiasis 5
- Biological factors, such as age and sex, which can also increase the risk of developing choledocholithiasis 5
- Behavioral intervention factors, such as diet and lifestyle, which can contribute to the formation of stones in the common bile duct 5
Risk Factors for Recurrence
The risk factors for recurrence of choledocholithiasis include:
- First-episode stone related factors, such as the size and number of stones 5
- Congenital factors, such as abnormalities in the biliary tree 5
- Biological factors, such as age and sex 5
- Behavioral intervention factors, such as diet and lifestyle 5
- The number of stone recurrences, which can increase the risk of further recurrence 5
Management Strategies
To manage choledocholithiasis, several strategies can be employed, including:
- Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy, which is a common and effective treatment for choledocholithiasis 2, 6, 3, 4
- Laparoscopic or open common bile duct exploration, which can be used to remove stones from the common bile duct 6, 3, 4
- Percutaneous radiological interventions, which can be used to remove stones from the common bile duct 3, 4
- Dissolving solutions, extracorporeal shockwave lithotripsy (ESWL), electrohydraulic lithotripsy (EHL), and laser lithotripsy, which can be used to break up or dissolve stones in the common bile duct 4