Natural history of asymptomatic bile duct stones and association of endoscopic treatment with clinical outcomes
Background Due to increasing opportunities for abdominal imaging studies, bile duct stones are occasionally diagnosed without any symptoms. However, there has been no consensus on the management of asymptomatic bile duct stones. We conducted a retrospective longitudinal cohort study to investigate t...
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| Veröffentlicht in: | Journal of gastroenterology 2020, Vol.55 (1), p.78-85 |
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| creator | Hakuta, Ryunosuke Hamada, Tsuyoshi Nakai, Yousuke Oyama, Hiroki Kanai, Sachiko Suzuki, Tatsunori Sato, Tatsuya Ishigaki, Kazunaga Saito, Kei Saito, Tomotaka Takahara, Naminatsu Mizuno, Suguru Kogure, Hirofumi Watadani, Takeyuki Tsujino, Takeshi Tada, Minoru Abe, Osamu Isayama, Hiroyuki Koike, Kazuhiko |
| description | Background
Due to increasing opportunities for abdominal imaging studies, bile duct stones are occasionally diagnosed without any symptoms. However, there has been no consensus on the management of asymptomatic bile duct stones. We conducted a retrospective longitudinal cohort study to investigate the natural history of asymptomatic bile duct stones and clinical outcomes according to the timing of endoscopic removal.
Methods
We identified consecutive patients who were diagnosed with asymptomatic common bile duct stones and categorized into those who were followed up with stones in situ (wait-and-see group) and those who received early endoscopic stone removal (intervention group). Cumulative incidence functions of biliary complications were estimated and compared between the groups.
Results
We included 191 patients (114 patients in the wait-and-see group and 77 patients in the intervention group). In the wait-and-see group, the cumulative incidence of biliary complications was 6.1% at 1 year, 11% at 3 years, and 17% at 5 years. Asymptomatic disappearance of stones was observed in 22 patients (19%). Procedure-related adverse events of early endoscopic stone removal of asymptomatic stones were observed in 25 (32%) patients including 4 (5.2%) with severe pancreatitis. The cumulative incidence function of biliary complications did not differ by treatment strategies (
P
= 0.55).
Conclusions
Biliary complications occurred in a substantial proportion of patients with asymptomatic bile duct stones, but early endoscopic removal appeared to have little effect on the prevention of further biliary complications. Given the risk of procedure-related pancreatitis, the wait-and-see strategy may become a management option of asymptomatic stones. |
| doi_str_mv | 10.1007/s00535-019-01612-7 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2283298952</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A714583136</galeid><sourcerecordid>A714583136</sourcerecordid><originalsourceid>FETCH-LOGICAL-c466t-70f0a6b418c572fb5b4dc0a8f5dac17cb815760a98d5e11295c59e4c0200f6f83</originalsourceid><addsrcrecordid>eNp9kU9rFTEUxYMo9rX1C7iQATdupr35N0mWpagVit3YdchkkjZlJnkmGeR9e_P6qkURCSFw7-8cbu5B6C2GMwwgzgsAp7wHrNodMOnFC7TBrJW4IuQl2oBirMdYsCN0XMoDAKbA5Wt0RDETVBK5QemrqWs2c3cfSk151yXfmbJbtjUtpgbbjWF23bTa2rV-dKUzcWpESTa0fop7gYtTKjZtG16zM3VxsXY_Qr3v7BxisM0-rdWmxZVT9Mqbubg3T-8Juv308dvlVX998_nL5cV1b9kw1F6ABzOMDEvLBfEjH9lkwUjPJ2OxsKPEXAxglJy4w5gobrlyzAIB8IOX9AR9OPhuc_q-ulL1Eop182yiS2vRhEhKlFScNPT9X-hDWnNs0z1SclCC4WfqzsxOh-hTzcbuTfWFwIxLiunQqLN_UO1Mbgm27c-3df4pIAeBzamU7Lze5rCYvNMY9D5lfUhZt5T1Y8paNNG7p4nXcXHTb8mvWBtAD0BprXjn8vOX_mP7Ey07sg4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2283869741</pqid></control><display><type>article</type><title>Natural history of asymptomatic bile duct stones and association of endoscopic treatment with clinical outcomes</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Hakuta, Ryunosuke ; Hamada, Tsuyoshi ; Nakai, Yousuke ; Oyama, Hiroki ; Kanai, Sachiko ; Suzuki, Tatsunori ; Sato, Tatsuya ; Ishigaki, Kazunaga ; Saito, Kei ; Saito, Tomotaka ; Takahara, Naminatsu ; Mizuno, Suguru ; Kogure, Hirofumi ; Watadani, Takeyuki ; Tsujino, Takeshi ; Tada, Minoru ; Abe, Osamu ; Isayama, Hiroyuki ; Koike, Kazuhiko</creator><creatorcontrib>Hakuta, Ryunosuke ; Hamada, Tsuyoshi ; Nakai, Yousuke ; Oyama, Hiroki ; Kanai, Sachiko ; Suzuki, Tatsunori ; Sato, Tatsuya ; Ishigaki, Kazunaga ; Saito, Kei ; Saito, Tomotaka ; Takahara, Naminatsu ; Mizuno, Suguru ; Kogure, Hirofumi ; Watadani, Takeyuki ; Tsujino, Takeshi ; Tada, Minoru ; Abe, Osamu ; Isayama, Hiroyuki ; Koike, Kazuhiko</creatorcontrib><description>Background
Due to increasing opportunities for abdominal imaging studies, bile duct stones are occasionally diagnosed without any symptoms. However, there has been no consensus on the management of asymptomatic bile duct stones. We conducted a retrospective longitudinal cohort study to investigate the natural history of asymptomatic bile duct stones and clinical outcomes according to the timing of endoscopic removal.
Methods
We identified consecutive patients who were diagnosed with asymptomatic common bile duct stones and categorized into those who were followed up with stones in situ (wait-and-see group) and those who received early endoscopic stone removal (intervention group). Cumulative incidence functions of biliary complications were estimated and compared between the groups.
Results
We included 191 patients (114 patients in the wait-and-see group and 77 patients in the intervention group). In the wait-and-see group, the cumulative incidence of biliary complications was 6.1% at 1 year, 11% at 3 years, and 17% at 5 years. Asymptomatic disappearance of stones was observed in 22 patients (19%). Procedure-related adverse events of early endoscopic stone removal of asymptomatic stones were observed in 25 (32%) patients including 4 (5.2%) with severe pancreatitis. The cumulative incidence function of biliary complications did not differ by treatment strategies (
P
= 0.55).
Conclusions
Biliary complications occurred in a substantial proportion of patients with asymptomatic bile duct stones, but early endoscopic removal appeared to have little effect on the prevention of further biliary complications. Given the risk of procedure-related pancreatitis, the wait-and-see strategy may become a management option of asymptomatic stones.</description><identifier>ISSN: 0944-1174</identifier><identifier>EISSN: 1435-5922</identifier><identifier>DOI: 10.1007/s00535-019-01612-7</identifier><identifier>PMID: 31473828</identifier><language>eng</language><publisher>Tokyo: Springer Japan</publisher><subject>Abdominal Surgery ; Aged ; Aged, 80 and over ; Asymptomatic Diseases ; Bile ; Bile ducts ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde - adverse effects ; Cholangitis ; Clinical outcomes ; Colorectal Surgery ; Disease Progression ; Endoscopy ; Female ; Gallstones - complications ; Gallstones - diagnostic imaging ; Gallstones - therapy ; Gastroenterology ; Hepatology ; Humans ; Longitudinal Studies ; Male ; Medical colleges ; Medicine ; Medicine & Public Health ; Original Article—Liver ; Pancreas ; Pancreatitis ; Pancreatitis - epidemiology ; Pancreatitis - etiology ; Patient outcomes ; Patients ; Retrospective Studies ; Sphincterotomy, Endoscopic - adverse effects ; Surgical Oncology ; Treatment Outcome ; Watchful Waiting</subject><ispartof>Journal of gastroenterology, 2020, Vol.55 (1), p.78-85</ispartof><rights>Japanese Society of Gastroenterology 2019</rights><rights>COPYRIGHT 2020 Springer</rights><rights>Journal of Gastroenterology is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c466t-70f0a6b418c572fb5b4dc0a8f5dac17cb815760a98d5e11295c59e4c0200f6f83</citedby><cites>FETCH-LOGICAL-c466t-70f0a6b418c572fb5b4dc0a8f5dac17cb815760a98d5e11295c59e4c0200f6f83</cites><orcidid>0000-0001-7411-1385</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00535-019-01612-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00535-019-01612-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31473828$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hakuta, Ryunosuke</creatorcontrib><creatorcontrib>Hamada, Tsuyoshi</creatorcontrib><creatorcontrib>Nakai, Yousuke</creatorcontrib><creatorcontrib>Oyama, Hiroki</creatorcontrib><creatorcontrib>Kanai, Sachiko</creatorcontrib><creatorcontrib>Suzuki, Tatsunori</creatorcontrib><creatorcontrib>Sato, Tatsuya</creatorcontrib><creatorcontrib>Ishigaki, Kazunaga</creatorcontrib><creatorcontrib>Saito, Kei</creatorcontrib><creatorcontrib>Saito, Tomotaka</creatorcontrib><creatorcontrib>Takahara, Naminatsu</creatorcontrib><creatorcontrib>Mizuno, Suguru</creatorcontrib><creatorcontrib>Kogure, Hirofumi</creatorcontrib><creatorcontrib>Watadani, Takeyuki</creatorcontrib><creatorcontrib>Tsujino, Takeshi</creatorcontrib><creatorcontrib>Tada, Minoru</creatorcontrib><creatorcontrib>Abe, Osamu</creatorcontrib><creatorcontrib>Isayama, Hiroyuki</creatorcontrib><creatorcontrib>Koike, Kazuhiko</creatorcontrib><title>Natural history of asymptomatic bile duct stones and association of endoscopic treatment with clinical outcomes</title><title>Journal of gastroenterology</title><addtitle>J Gastroenterol</addtitle><addtitle>J Gastroenterol</addtitle><description>Background
Due to increasing opportunities for abdominal imaging studies, bile duct stones are occasionally diagnosed without any symptoms. However, there has been no consensus on the management of asymptomatic bile duct stones. We conducted a retrospective longitudinal cohort study to investigate the natural history of asymptomatic bile duct stones and clinical outcomes according to the timing of endoscopic removal.
Methods
We identified consecutive patients who were diagnosed with asymptomatic common bile duct stones and categorized into those who were followed up with stones in situ (wait-and-see group) and those who received early endoscopic stone removal (intervention group). Cumulative incidence functions of biliary complications were estimated and compared between the groups.
Results
We included 191 patients (114 patients in the wait-and-see group and 77 patients in the intervention group). In the wait-and-see group, the cumulative incidence of biliary complications was 6.1% at 1 year, 11% at 3 years, and 17% at 5 years. Asymptomatic disappearance of stones was observed in 22 patients (19%). Procedure-related adverse events of early endoscopic stone removal of asymptomatic stones were observed in 25 (32%) patients including 4 (5.2%) with severe pancreatitis. The cumulative incidence function of biliary complications did not differ by treatment strategies (
P
= 0.55).
Conclusions
Biliary complications occurred in a substantial proportion of patients with asymptomatic bile duct stones, but early endoscopic removal appeared to have little effect on the prevention of further biliary complications. Given the risk of procedure-related pancreatitis, the wait-and-see strategy may become a management option of asymptomatic stones.</description><subject>Abdominal Surgery</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Asymptomatic Diseases</subject><subject>Bile</subject><subject>Bile ducts</subject><subject>Biliary Tract</subject><subject>Cholangiopancreatography, Endoscopic Retrograde - adverse effects</subject><subject>Cholangitis</subject><subject>Clinical outcomes</subject><subject>Colorectal Surgery</subject><subject>Disease Progression</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Gallstones - complications</subject><subject>Gallstones - diagnostic imaging</subject><subject>Gallstones - therapy</subject><subject>Gastroenterology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medical colleges</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article—Liver</subject><subject>Pancreas</subject><subject>Pancreatitis</subject><subject>Pancreatitis - epidemiology</subject><subject>Pancreatitis - etiology</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Sphincterotomy, Endoscopic - adverse effects</subject><subject>Surgical Oncology</subject><subject>Treatment Outcome</subject><subject>Watchful Waiting</subject><issn>0944-1174</issn><issn>1435-5922</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kU9rFTEUxYMo9rX1C7iQATdupr35N0mWpagVit3YdchkkjZlJnkmGeR9e_P6qkURCSFw7-8cbu5B6C2GMwwgzgsAp7wHrNodMOnFC7TBrJW4IuQl2oBirMdYsCN0XMoDAKbA5Wt0RDETVBK5QemrqWs2c3cfSk151yXfmbJbtjUtpgbbjWF23bTa2rV-dKUzcWpESTa0fop7gYtTKjZtG16zM3VxsXY_Qr3v7BxisM0-rdWmxZVT9Mqbubg3T-8Juv308dvlVX998_nL5cV1b9kw1F6ABzOMDEvLBfEjH9lkwUjPJ2OxsKPEXAxglJy4w5gobrlyzAIB8IOX9AR9OPhuc_q-ulL1Eop182yiS2vRhEhKlFScNPT9X-hDWnNs0z1SclCC4WfqzsxOh-hTzcbuTfWFwIxLiunQqLN_UO1Mbgm27c-3df4pIAeBzamU7Lze5rCYvNMY9D5lfUhZt5T1Y8paNNG7p4nXcXHTb8mvWBtAD0BprXjn8vOX_mP7Ey07sg4</recordid><startdate>2020</startdate><enddate>2020</enddate><creator>Hakuta, Ryunosuke</creator><creator>Hamada, Tsuyoshi</creator><creator>Nakai, Yousuke</creator><creator>Oyama, Hiroki</creator><creator>Kanai, Sachiko</creator><creator>Suzuki, Tatsunori</creator><creator>Sato, Tatsuya</creator><creator>Ishigaki, Kazunaga</creator><creator>Saito, Kei</creator><creator>Saito, Tomotaka</creator><creator>Takahara, Naminatsu</creator><creator>Mizuno, Suguru</creator><creator>Kogure, Hirofumi</creator><creator>Watadani, Takeyuki</creator><creator>Tsujino, Takeshi</creator><creator>Tada, Minoru</creator><creator>Abe, Osamu</creator><creator>Isayama, Hiroyuki</creator><creator>Koike, Kazuhiko</creator><general>Springer Japan</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7411-1385</orcidid></search><sort><creationdate>2020</creationdate><title>Natural history of asymptomatic bile duct stones and association of endoscopic treatment with clinical outcomes</title><author>Hakuta, Ryunosuke ; Hamada, Tsuyoshi ; Nakai, Yousuke ; Oyama, Hiroki ; Kanai, Sachiko ; Suzuki, Tatsunori ; Sato, Tatsuya ; Ishigaki, Kazunaga ; Saito, Kei ; Saito, Tomotaka ; Takahara, Naminatsu ; Mizuno, Suguru ; Kogure, Hirofumi ; Watadani, Takeyuki ; Tsujino, Takeshi ; Tada, Minoru ; Abe, Osamu ; Isayama, Hiroyuki ; Koike, Kazuhiko</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c466t-70f0a6b418c572fb5b4dc0a8f5dac17cb815760a98d5e11295c59e4c0200f6f83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Abdominal Surgery</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Asymptomatic Diseases</topic><topic>Bile</topic><topic>Bile ducts</topic><topic>Biliary Tract</topic><topic>Cholangiopancreatography, Endoscopic Retrograde - adverse effects</topic><topic>Cholangitis</topic><topic>Clinical outcomes</topic><topic>Colorectal Surgery</topic><topic>Disease Progression</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Gallstones - complications</topic><topic>Gallstones - diagnostic imaging</topic><topic>Gallstones - therapy</topic><topic>Gastroenterology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medical colleges</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article—Liver</topic><topic>Pancreas</topic><topic>Pancreatitis</topic><topic>Pancreatitis - epidemiology</topic><topic>Pancreatitis - etiology</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Sphincterotomy, Endoscopic - adverse effects</topic><topic>Surgical Oncology</topic><topic>Treatment Outcome</topic><topic>Watchful Waiting</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hakuta, Ryunosuke</creatorcontrib><creatorcontrib>Hamada, Tsuyoshi</creatorcontrib><creatorcontrib>Nakai, Yousuke</creatorcontrib><creatorcontrib>Oyama, Hiroki</creatorcontrib><creatorcontrib>Kanai, Sachiko</creatorcontrib><creatorcontrib>Suzuki, Tatsunori</creatorcontrib><creatorcontrib>Sato, Tatsuya</creatorcontrib><creatorcontrib>Ishigaki, Kazunaga</creatorcontrib><creatorcontrib>Saito, Kei</creatorcontrib><creatorcontrib>Saito, Tomotaka</creatorcontrib><creatorcontrib>Takahara, Naminatsu</creatorcontrib><creatorcontrib>Mizuno, Suguru</creatorcontrib><creatorcontrib>Kogure, Hirofumi</creatorcontrib><creatorcontrib>Watadani, Takeyuki</creatorcontrib><creatorcontrib>Tsujino, Takeshi</creatorcontrib><creatorcontrib>Tada, Minoru</creatorcontrib><creatorcontrib>Abe, Osamu</creatorcontrib><creatorcontrib>Isayama, Hiroyuki</creatorcontrib><creatorcontrib>Koike, Kazuhiko</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastroenterology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hakuta, Ryunosuke</au><au>Hamada, Tsuyoshi</au><au>Nakai, Yousuke</au><au>Oyama, Hiroki</au><au>Kanai, Sachiko</au><au>Suzuki, Tatsunori</au><au>Sato, Tatsuya</au><au>Ishigaki, Kazunaga</au><au>Saito, Kei</au><au>Saito, Tomotaka</au><au>Takahara, Naminatsu</au><au>Mizuno, Suguru</au><au>Kogure, Hirofumi</au><au>Watadani, Takeyuki</au><au>Tsujino, Takeshi</au><au>Tada, Minoru</au><au>Abe, Osamu</au><au>Isayama, Hiroyuki</au><au>Koike, Kazuhiko</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Natural history of asymptomatic bile duct stones and association of endoscopic treatment with clinical outcomes</atitle><jtitle>Journal of gastroenterology</jtitle><stitle>J Gastroenterol</stitle><addtitle>J Gastroenterol</addtitle><date>2020</date><risdate>2020</risdate><volume>55</volume><issue>1</issue><spage>78</spage><epage>85</epage><pages>78-85</pages><issn>0944-1174</issn><eissn>1435-5922</eissn><abstract>Background
Due to increasing opportunities for abdominal imaging studies, bile duct stones are occasionally diagnosed without any symptoms. However, there has been no consensus on the management of asymptomatic bile duct stones. We conducted a retrospective longitudinal cohort study to investigate the natural history of asymptomatic bile duct stones and clinical outcomes according to the timing of endoscopic removal.
Methods
We identified consecutive patients who were diagnosed with asymptomatic common bile duct stones and categorized into those who were followed up with stones in situ (wait-and-see group) and those who received early endoscopic stone removal (intervention group). Cumulative incidence functions of biliary complications were estimated and compared between the groups.
Results
We included 191 patients (114 patients in the wait-and-see group and 77 patients in the intervention group). In the wait-and-see group, the cumulative incidence of biliary complications was 6.1% at 1 year, 11% at 3 years, and 17% at 5 years. Asymptomatic disappearance of stones was observed in 22 patients (19%). Procedure-related adverse events of early endoscopic stone removal of asymptomatic stones were observed in 25 (32%) patients including 4 (5.2%) with severe pancreatitis. The cumulative incidence function of biliary complications did not differ by treatment strategies (
P
= 0.55).
Conclusions
Biliary complications occurred in a substantial proportion of patients with asymptomatic bile duct stones, but early endoscopic removal appeared to have little effect on the prevention of further biliary complications. Given the risk of procedure-related pancreatitis, the wait-and-see strategy may become a management option of asymptomatic stones.</abstract><cop>Tokyo</cop><pub>Springer Japan</pub><pmid>31473828</pmid><doi>10.1007/s00535-019-01612-7</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-7411-1385</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0944-1174 |
| ispartof | Journal of gastroenterology, 2020, Vol.55 (1), p.78-85 |
| issn | 0944-1174 1435-5922 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2283298952 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Abdominal Surgery Aged Aged, 80 and over Asymptomatic Diseases Bile Bile ducts Biliary Tract Cholangiopancreatography, Endoscopic Retrograde - adverse effects Cholangitis Clinical outcomes Colorectal Surgery Disease Progression Endoscopy Female Gallstones - complications Gallstones - diagnostic imaging Gallstones - therapy Gastroenterology Hepatology Humans Longitudinal Studies Male Medical colleges Medicine Medicine & Public Health Original Article—Liver Pancreas Pancreatitis Pancreatitis - epidemiology Pancreatitis - etiology Patient outcomes Patients Retrospective Studies Sphincterotomy, Endoscopic - adverse effects Surgical Oncology Treatment Outcome Watchful Waiting |
| title | Natural history of asymptomatic bile duct stones and association of endoscopic treatment with clinical outcomes |
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