Management of suspected stones in the common bile duct.
نویسندگان
چکیده
884 CMAJ, May 15, 2012, 184(8) © 2012 Canadian Medical Association or its licensors Gallstone disease is responsible for about 1.8 million ambulatory care visits and more than 700 000 cholecystectomies yearly in the United States. In Canada, the adjusted annual rate of elective cholecystectomy was 260.8 per 100 000 population during the period 1992–2000. Gallstone disease is the second most common reason for hospital admissions (with an estimated cost of US$5.8 billion annually), although only 15% of people with gallstones have related symptoms. One complication is the occurrence of stones in the common bile duct. Stones in the common bile duct most commonly re sult from the passage of gallstones through the cystic duct into the common bile duct. Less frequently, they may originate in the common bile duct itself. Stones in the common bile duct can cause biliary obstruction, cholangitis, pancreatitis, or secondary biliary cirrhosis in patients who have had the stones for a long time. More than 1 in 10 patients (10%–18%) undergoing cholecystectomy for gallstones have concomitant common bile duct stones, and up to 3.8% have symptoms related to common bile duct stones during the first year after cholecystectomy. The management of patients with gallstone disease suspected of having stones in the common bile duct has three aims: to evaluate the probability of stones in the common bile duct, to treat these stones when present, and to treat the stones in the gallbladder. In this article, we review the development of practical approaches to the first two aims. A summary of the evidence we used in our review is available in Box 1. Most of the identified studies describing the natural history of common bile duct stones and relevant imaging modalities were observational in design; studies reporting therapeutic outcomes were based on randomized trials and meta-analyses.
منابع مشابه
Updated guideline on the management of common bile duct stones (CBDS).
Common bile duct stones (CBDS) are estimated to be present in 10-20% of individuals with symptomatic gallstones. They can result in a number of health problems, including pain, jaundice, infection and acute pancreatitis. A variety of imaging modalities can be employed to identify the condition, while management of confirmed cases of CBDS may involve endoscopic retrograde cholangiopancreatograph...
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ورودعنوان ژورنال:
- CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
دوره 184 8 شماره
صفحات -
تاریخ انتشار 2012