From the Guidelines
Choledocolithiasis is a medical condition characterized by the presence of gallstones in the common bile duct, requiring prompt medical attention to prevent serious complications such as acute cholangitis, pancreatitis, or biliary obstruction. This condition occurs when stones form in the gallbladder and migrate into the bile duct, or less commonly, when stones form directly within the duct itself 1. Patients with choledocolithiasis often experience symptoms including:
- Severe upper abdominal pain
- Jaundice (yellowing of the skin and eyes)
- Fever
- Chills
- Nausea
- Vomiting
- Dark urine
Diagnosis typically involves:
- Blood tests to check liver function
- Ultrasound imaging
- Magnetic resonance cholangiopancreatography (MRCP)
- Endoscopic retrograde cholangiopancreatography (ERCP) 1
Treatment usually consists of ERCP with sphincterotomy to remove the stones, followed by cholecystectomy (gallbladder removal) to prevent recurrence 1. In some cases, medication such as ursodeoxycholic acid might be prescribed to dissolve small stones, though this approach is less common. The condition develops because cholesterol or bilirubin in bile can crystallize and form stones when the bile becomes concentrated in the gallbladder, particularly in individuals with risk factors such as obesity, rapid weight loss, certain medications, or genetic predisposition 1. The mainstay of therapy for choledocholithiasis is endoscopic biliary sphincterotomy and stone extraction during ERCP, with a reported success rate of 90% 1.
From the Research
Definition and Prevalence of Choledocolithiasis
- Choledocholithiasis occurs in up to approximately 20% of patients with cholelithiasis 2
- It is a common presentation of symptomatic cholelithiasis that can result in biliary obstruction, cholangitis, and pancreatitis 3
- The prevalence of choledocholithiasis is 10% to 20% 4
Causes and Symptoms
- A majority of stones form in the gallbladder and then pass into the common bile duct, where they generate symptoms, due to biliary obstruction 2
- Symptoms can include right upper quadrant pain, fever, and leukocytosis 4
Diagnosis and Treatment
- Confirmatory diagnosis of choledocholithiasis is made with advanced imaging, including magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) 2
- Treatment varies locally; however, ERCP with sphincterotomy is most commonly employed with a high degree of success 2
- Difficult anatomy and difficult stone burden require advanced surgical, endoscopic, and percutaneous techniques to extract or expel biliary stones 2, 5
- The goal of management in individuals with choledocholithiasis consists of clearing common bile duct stones 4