Management of Common Bile Duct Stones: A Comprehensive Review
| Autor: | Zia Aftab, Syed Muhammad Ali, Ahmed Zarour, Mohannad Al-Tarakji, Inamullah, Fakhar Shahid, Burhan Khan, Ejaz Latif |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Endoscopic ultrasound
medicine.medical_specialty Polymers and Plastics Common bile duct medicine.diagnostic_test business.industry Bile duct medicine.medical_treatment Gallstones Biliary colic Lithotripsy medicine.disease Laser lithotripsy Industrial and Manufacturing Engineering Surgery medicine.anatomical_structure Cholangiography medicine Business and International Management medicine.symptom business |
| Zdroj: | Biomedical Sciences. 6:102 |
| ISSN: | 2575-3924 |
| DOI: | 10.11648/j.bs.20200604.15 |
| Popis: | Bile duct stones (BDS) are usually secondary to gallstones but may be found primarily in biliary system, although the percentage is minimal. They are usually suspected on history and clinical examination alone but symptoms may be variable ranging from asymptomatic to complications such as biliary colic, pancreatitis, jaundice or cholangitis, the latter can be life-threatening in some patients. Abnormalities in the liver function tests especially the elevated direct bilirubin and alkaline phosphatase indirectly raise the suspicion. The majority of BDS can be diagnosed by Transabdominal Ultrasound, but in some cases further imaging such as, Computed Tomography, Endoscopic Ultrasound or Magnetic Resonance Cholangiography are employed prior to endoscopic or laparoscopic removal. Approximately 90% of BDS can be removed following Endoscopic Retrograde Cholangiography (ERC) + sphincterotomy. Most of the remaining stones can be removed using mechanical lithotripsy. Patients with uncorrected coagulopathies may be treated with ERC + pneumatic dilatation of the sphincter of Oddi. Shockwave lithotripsy (intraductal and extracorporeal) and laser lithotripsy have also been used to fragment large bile duct stones prior to endoscopic removal. Despite all the minimally invasive procedures the role of open surgery for the removal of difficult or impacted stones cannot be completely forgotten. The role of medical therapy in treatment of BDS is currently uncertain. This review focuses on the clinical presentation, investigation and current management of BDS. |
| Databáze: | OpenAIRE |
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