From the Guidelines
Approximately 10% of patients with gallstone disease have common bile duct (CBD) stones, which can lead to gallstone pancreatitis. This estimate is based on the most recent and highest quality study available, which suggests that CBD stones are present in around 10% of those with gallstone disease 1. The pathophysiology of gallstone pancreatitis typically involves the migration of gallstones from the gallbladder into the common bile duct, causing obstruction of the pancreatic duct or its shared opening with the bile duct, leading to pancreatic enzyme activation and inflammation.
Key Points
- The prevalence of CBD stones in patients with gallstone disease is estimated to be around 10% 1.
- Gallstone pancreatitis often occurs when gallstones migrate into the common bile duct and cause obstruction of the pancreatic duct or its shared opening with the bile duct.
- The presence of CBD stones is a significant risk factor for developing obstructive jaundice, cholangitis, acute pancreatitis, and potentially secondary biliary cirrhosis.
- Biliary evaluation and clearance are crucial in patients with gallstone pancreatitis, typically through endoscopic retrograde cholangiopancreatography (ERCP) for those with evidence of ongoing biliary obstruction or cholangitis, followed by cholecystectomy to prevent recurrence.
Clinical Implications
- Clinicians should be aware of the potential for CBD stones in patients with gallstone disease and consider biliary evaluation and clearance in those with suspected or confirmed gallstone pancreatitis.
- The management of CBD stones may involve ERCP, surgery, and radiological methods of stone extraction, and clinicians should be familiar with the various options and their indications 1.
From the Research
Gallstone Pancreatitis and Common Bile Duct Stones
- The percentage of gallstone pancreatitis cases with common bile duct (CBD) stones is estimated to be around 15% to 21% 2, 3.
- A study published in 2008 found that 10% of patients with gallstone pancreatitis had CBD stones 2.
- Another study published in 1998 found that 21% of patients with gallstone pancreatitis had persistent CBD stones 3.
- The incidence of cholangitis in gallstone pancreatitis is relatively low, around 3% 3.
- Serum total bilirubin level on hospital day 2 is a useful predictor of persistent CBD stones, with a sensitivity of 90.5% and specificity of 63% 3.
- A total bilirubin level of 4 mg/dL or greater on hospital day 2 can predict persisting CBD stones with enough specificity to serve as a practical guideline for ERCP 2.