Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec;68(12):4456-4465.
doi: 10.1007/s10620-023-08137-3. Epub 2023 Oct 27.

Non-interventional Management of Asymptomatic Diminutive Choledocholithiasis Versus Endoscopic Extraction in Consecutive Patients

Atsuto Kayashima  1 , Masayasu Horibe  1   2 , Eisuke Iwasaki  3 , Fateh Bazerbachi  4 , Haruka Okada  1 , Yuki Nakajima  1 , Yosuke Mizukami  1 , Yujiro Machida  1 , Shintaro Kawasaki  1 , Minoru Kitago  5 , Takanori Kanai  1
Affiliations

Non-interventional Management of Asymptomatic Diminutive Choledocholithiasis Versus Endoscopic Extraction in Consecutive Patients

Atsuto Kayashima et al. Dig Dis Sci. 2023 Dec.

Abstract

Background: Current guidelines recommend treating choledocholithiasis, regardless of symptoms or stone size, with endoscopic retrograde cholangiopancreatography (ERCP). However, asymptomatic choledocholithiasis, discovered incidentally on imaging, may carry a higher risk of ERCP-related adverse events, and some asymptomatic and diminutive stones may not cause biliary adverse events during extended follow-up. Therefore, we aimed to clarify the best treatment strategies for asymptomatic choledocholithiasis based on stone size.

Methods: We retrospectively identified patients with incidental imaging-found asymptomatic diminutive (≤ 4 mm) or non-diminutive (> 4 mm) choledocholithiasis and divided them into two groups: those who did not undergo ERCP and were treated when complications arose (on-demand group) and those who underwent ERCP before being symptomatic (intervention group). Adverse events were defined as any biliary or pancreatic complication related to ERCP or arising during observation or after intervention. The primary outcome was the adjusted overall adverse event-free survival using the propensity score-based matching weights method comparing the two groups of stone size.

Results: Among 148 patients identified (median follow-up period, 969 days), 68 had diminutive stones and 80 had non-diminutive stones. Of the 68 patients with diminutive stones, 51 were in the on-demand group and 17 in the intervention group. The overall adjusted adverse event-free survival was significantly higher in the on-demand group for diminutive stones (97.4% and 70.1%, respectively, at 3 years; p = 0.01).

Discussion: Patients with incidental imaging-detected asymptomatic diminutive choledocholithiasis may benefit from clinical observation, pursuing ERCP when symptoms develop.

Keywords: Asymptomatic diseases; Choledocholithiasis; Endoscopic retrograde cholangiopancreatography; Follow-up studies; Watch-and-wait.

PubMed Disclaimer

References

    1. Everhart JE, Khare M, Hill M, Maurer KR. Prevalence and ethnic differences in gallbladder disease in the United States. Gastroenterology. 1999;117:632–639. - DOI - PubMed
    1. Tazuma S. Gallstone disease: Epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic). Best Pract Res Clin Gastroenterol. 2006;20:1075–1083. - DOI - PubMed
    1. Manes G, Paspatis G, Aabakken L et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2019;51:472–491. - DOI - PubMed
    1. ASGE Standards of Practice Committee, Maple JT, Ikenberry SO et al. The role of endoscopy in the management of choledocholithiasis. Gastrointest Endosc. 2011;74:731–744. - DOI
    1. Tazuma S, Unno M, Igarashi Y et al. Evidence-based clinical practice guidelines for cholelithiasis 2016. J Gastroenterol. 2017;52:276–300. - DOI - PubMed

MeSH terms

LinkOut - more resources