Introduction

Common bile duct stones (CBDS) can spontaneously migrate through the duodenal papilla. In this case, ERCP could be unnecessary and a significant rate of complications could be avoided. In this study, we aim at retrospectively evaluating the rate of spontaneous stone passage in patients with an imaging diagnosis of CBDS and at analysing the factors associated to spontaneous stone migration.

Methods

We conducted a retrospective multi-centre analysis of patients undergoing ERCP for CBDS in a 12-month period. 1016 patients with CBDS were analysed. In all patients CBDS was diagnosed with adequate imaging methods performed prior to ERCP. ERCPs with failed biliary cannulation were excluded. Data regarding patients’ characteristics, imaging findings and ERCP procedure were analysed.

Results

1016 patients with CBDS undergoing ERCP were analysed (male sex 43.3%; mean age 69.9 ± 16.5 years). Diagnosis of CBDS was obtained by EUS in 415 patients (40.8%), MR in 343 (33.8%), CT in 220 (21.7%), and US in 38 (3.7%). No stones were found at ERCP in 179 patients (17.6%), in 14 (6.2%) when ERCP was performed within 6 h from imaging study, in 114 (18.5%) between 7 h and 7 days, in 32 (24.6%) between 8 and 29 days, and in 19 (43.2%) after 30 days. The rate of unnecessary ERCP occurred significantly more frequently in patients in whom imaging methods demonstrated either sludge or ≤ 5 mm CBDS (29.9 vs. 8.3%; p < 0.001).

Discussion

Spontaneous migration of small CBDS is a frequent event, and ≤ 5 mm size and a delay in ERCP > 7 days represent predictive factors for it. We suggest that CBDS ≤ 5 mm should not undergo immediate removal and this fact would allow reducing the rate of unnecessary ERCP with their related complications. Prospective studies are needed to confirm these results and demonstrate the safety of a conservative management in this setting.

中文翻译：

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小尺寸胆总管结石的高自发迁移率可显着减少不必要的 ERCP 和相关并发症：一项回顾性、多中心研究的结果

介绍

胆总管结石 (CBDS) 可以通过十二指肠乳头自发迁移。在这种情况下，ERCP 可能是不必要的，并且可以避免显着的并发症发生率。在本研究中，我们旨在回顾性评估影像学诊断为 CBDS 的患者的自发性结石排出率，并分析与自发性结石移位相关的因素。

方法

我们在 12 个月内对接受 ERCP 治疗 CBDS 的患者进行了回顾性多中心分析。分析了 1016 名 CBDS 患者。在所有患者中，在 ERCP 之前使用适当的成像方法诊断出 CBDS。胆管插管失败的 ERCP 被排除在外。分析了有关患者特征、影像学发现和 ERCP 程序的数据。

结果

分析了 1016 名接受 ERCP 的 CBDS 患者（男性 43.3%；平均年龄 69.9 ± 16.5 岁）。415 名患者（40.8%）通过 EUS 诊断 CBDS，343 名患者（33.8%）通过 MR 诊断，220 名患者（21.7%）通过 CT 诊断，38 名患者（3.7%）通过超声诊断。179 名患者 (17.6%) 在 ERCP 未发现结石，14 名患者 (6.2%) 在影像学检查后 6 小时内进行 ERCP，114 名患者 (18.5%) 在 7 小时至 7 天之间进行，32 名患者 (24.6%) 8 到 29 天之间，30 天后有 19 天（43.2%）。在影像学方法显示污泥或 ≤ 5 mm CBDS 的患者中，不必要的 ERCP 发生率明显更高（29.9 对 8.3%；p  < 0.001）。

讨论

小 CBDS 的自发迁移是一种常见事件，≤ 5 mm 大小和 ERCP 延迟 > 7 天是其预测因素。我们建议 CBDS ≤ 5 mm 不应立即切除，这一事实将减少不必要的 ERCP 及其相关并发症的发生率。需要前瞻性研究来证实这些结果并证明在这种情况下保守治疗的安全性。