Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. May 21, 2012; 18(19): 2396-2401
Published online May 21, 2012. doi: 10.3748/wjg.v18.i19.2396
Poorly expandable common bile duct with stones on endoscopic retrograde cholangiography
Chi-Liang Cheng, Yung-Kuan Tsou, Cheng-Hui Lin, Jui-Hsiang Tang, Chien-Fu Hung, Kai-Feng Sung, Ching-Song Lee, Nai-Jen Liu
Chi-Liang Cheng, Yung-Kuan Tsou, Cheng-Hui Lin, Jui-Hsiang Tang, Kai-Feng Sung, Ching-Song Lee, Nai-Jen Liu, Division of Therapeutic Endoscopy, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, China
Chien-Fu Hung, Division of Radiology, Department of Gastroenterology and Hepatology, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, China
Author contributions: Cheng CL and Tsou YK contributed equally to the paper; Cheng CL performed the conceptualization and design of the study; Tsou YK provided data analysis, data interpretation, and manuscript writing; Lin CH and Tang JH provided data collection, analysis, and interpretation; Hung CF was responsible for review of the cholangiograms; Sung KF and Lee CS provided data collection; Liu NJ was responsible for the manuscript revision and final approval of the version to be published.
Correspondence to: Dr. Nai-Jen Liu, Division of Therapeutic Endoscopy, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, China. launaijn.tw@yahoo.com.tw
Telephone: +886-3-3281200 Fax: +886-3-3272236
Received: January 5, 2012
Revised: March 2, 2012
Accepted: March 20, 2012
Published online: May 21, 2012
Abstract

AIM: To describe characteristics of a poorly expandable (PE) common bile duct (CBD) with stones on endoscopic retrograde cholangiography.

METHODS: A PE bile duct was characterized by a rigid and relatively narrowed distal CBD with retrograde dilatation of the non-PE segment. Between 2003 and 2006, endoscopic retrograde cholangiography (ERC) images and chart reviews of 1213 patients with newly diagnosed CBD stones were obtained from the computer database of Therapeutic Endoscopic Center in Chang Gung Memorial Hospital. Patients with characteristic PE bile duct on ERC were identified from the database. Data of the patients as well as the safety and technical success of therapeutic ERC were collected and analyzed retrospectively.

RESULTS: A total of 30 patients with CBD stones and characteristic PE segments were enrolled in this study. The median patient age was 45 years (range, 20 to 92 years); 66.7% of the patients were men. The diameters of the widest non-PE CBD segment, the PE segment, and the largest stone were 14.3 ± 4.9 mm, 5.8 ± 1.6 mm, and 11.2 ± 4.7 mm, respectively. The length of the PE segment was 39.7 ± 15.4 mm (range, 12.3 mm to 70.9 mm). To remove the CBD stone(s) completely, mechanical lithotripsy was required in 25 (83.3%) patients even though the stone size was not as large as were the difficult stones that have been described in the literature. The stone size and stone/PE segment diameter ratio were associated with the need for lithotripsy. Post-ERC complications occurred in 4 cases: pancreatitis in 1, cholangitis in 2, and an impacted Dormia basket with cholangitis in 1. Two (6.7%) of the 28 patients developed recurrent CBD stones at follow-up (50 ± 14 mo) and were successfully managed with therapeutic ERC.

CONCLUSION: Patients with a PE duct frequently require mechanical lithotripsy for stones extraction. To retrieve stones successfully and avoid complications, these patients should be identified during ERC.

Keywords: Common bile duct stone; Difficult stone; Endoscopic retrograde cholangiography; Mechanical lithotripsy