Common bile duct stone

Disease Overview (Causes and Symptoms)

• Definition: Stones that form in the common bile duct, a condition in which stones are present in or cause obstruction of the passage through which bile is discharged into the duodenum.
• Causes and pathophysiology:
  • Secondary common bile duct stones: Occur when gallbladder stones pass through the cystic duct and move into the common bile duct (originating in the gallbladder).
  • Primary common bile duct stones: Stones that form in the bile duct from the outset, which may be associated with bile stasis or bacterial or parasitic infection.
  • Bile stasis caused by stones promotes bacterial proliferation and can progress to acute cholangitis, abscesses, or sepsis. Bile duct obstruction can also affect the pancreatic duct and cause gallstone pancreatitis.
• Main symptoms:
  • Although they may be discovered incidentally without symptoms, they may occur along with bile duct dilation or abnormal liver function and cause abdominal pain (upper abdomen), nausea and vomiting, jaundice, chills, and fever (symptoms of cholangitis).
  • In cases of severe obstruction, the three major symptoms of upper abdominal pain, vomiting, jaundice, chills, and fever (typically pain, jaundice, and fever) may appear.

Treatment Methods

• Basic principle: Remove the stones and restore bile drainage. The urgency is determined according to the presence of symptoms and complications.
• Endoscopic treatment (standard):
  • Endoscopic retrograde cholangiopancreatography (ERCP) is used to perform sphincterotomy of the sphincter of Oddi (or dilation), followed by stone extraction. Diagnosis and treatment can be performed at the same time.
  • If acute cholangitis is suspected, administer antibiotics and perform drainage (ERCP) as quickly as possible.
• Surgical treatment:
  • If stones are also present in the gallbladder, laparoscopic cholecystectomy is performed after removal of the common bile duct stones, with the goal of preventing recurrence.
  • If an endoscopic approach is not possible (such as after previous gastrectomy), a percutaneous endoscopic method or surgical approach may be considered.
• Medication and conservative treatment:
  • If symptoms are mild and the stones are judged likely to pass spontaneously, observation may be appropriate (however, according to RAG materials, there are cases in which removal is recommended even when there are no symptoms).
  • If there is acute cholangitis or a risk of sepsis, broad-spectrum antibiotics may be administered (at the physician's discretion).
• Pre- and post-procedure management:
  • Confirm use of anticoagulants and follow instructions to discontinue them when necessary (due to the risk of bleeding).
  • Fast before the procedure and check for allergies and underlying diseases.
  • Monitor for complications such as bleeding, perforation, and pancreatitis after the procedure.

Outpatient Visit Checklist (Including Example Questions)

• Items to bring/information to provide:
  • A list of all medications currently being taken (especially anticoagulants, antiplatelet agents, antidiabetic medications, etc.)
  • History of drug allergies (e.g., contrast medium allergy)
  • Previous surgical history (especially upper gastrointestinal or gallbladder surgery, gastrectomy, etc.)
  • Recent test results (liver function tests, ultrasound/CT/MR findings, blood tests) or test reports/images
  • The time of symptom onset and progression (location, intensity, and frequency of pain; presence or absence of fever and jaundice); keeping a symptom diary can be useful
  • Underlying diseases (heart disease, lung disease, diabetes, etc.) and whether you are pregnant
• Show the medical staff during the outpatient visit:
  • Recent abdominal imaging (ultrasound, CT, MRI/MRCP, endoscopic findings, etc.)
  • Test values obtained (bilirubin, ALP, AST/ALT, etc.)
• Preparation for tests and procedures:
  • Fast in preparation for the possibility of ERCP (as instructed by the physician)
  • Whether to discontinue anticoagulants must be discussed with the treating physician in advance

Examples of General Questions to Ask the Doctor

• "Do I need an immediate procedure (ERCP) in this situation, or can I be monitored?"
• "What are the expected benefits and risks (complications) of each recommended treatment option?"
• "What are the main side effects of the medications to be prescribed (such as antibiotics or painkillers)?"
• "Are there any lifestyle changes I should make to prevent recurrence?"

Examples of Condition-Specific Questions

• "Can the current stone be completely removed by endoscopy (ERCP) based on its size and location? If not, what alternatives are available?"
• "I also have stones in my gallbladder. When do you recommend cholecystectomy after removing the common bile duct stones?"