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- Stones in common bile duct (CBD)
- 3 types: Cholesterol (majority), calcium bilirubinate or pigment, and mixed stones
- Pigment stones may form de novo in the CBD.
- System(s) affected: Gastrointestinal; Hepatobiliary
- Synonym(s): CBD stones; CBD calculi
- 700,000 cholecystectomies performed annually in the US:
- 4.6–20% of patients with gallstones have choledocholithiasis discovered at time of cholecystectomy, depending on whether routine cholangiography is used.
- Increases with age (30–50% of patients >60 with gallstones have CBD stones):
- On average, present 10 years older than cholelithiasis patients
- Incidence of gallstones in the US is 10–20%: Individuals >60 years old, up to 40%
- Internationally, incidence is increased due to parasitic infections (e.g., Ascaris lumbricoides).
- Choledocholithiasis found with intraoperative cholangiography may be a false positive, or may pass spontaneously without intervention.
Predominant sex: Female > Male
- Cholelithiasis (most CBD stones migrate from the gallbladder [GB] into CBD)
- Pancreatitis (30%)
- Higher consumption of long-chain saturated fatty acids (1)[A]
- Chronic hemolysis
- Estrogen exposure
- Weight loss >25% of original weight (especially rapidly) after bariatric surgery (2)[A]
- Prior cholecystectomy:
- <2 years prior: Considered a “retained” stone
- >2 years prior: Considered “recurrent” stone
- MDR3 defects may predispose to bile sludge formation, cholelithiasis, cholestasis of pregnancy, and subsequent choledocholithiasis.
- Increased prevalence in Hispanic population
Maintain a healthy weight and lifestyle, and avoid rapid loss of excess weight.
CBD stones may be primary or secondary:
- Primary stones form within the biliary tract: Caused by any condition leading to bile stasis or chronic bactibilia
- Secondary stones form within the gallbladder
- Cholelithiasis: Majority of stones
- Chronic hemolytic states
- Formation of de novo pigment stones:
- Dilated, sclerosed, or strictured ducts (e.g., from recurrent cholangitis)
- Hepatobiliary parasitism (A. lumbricoides or Clonorchis sinensis)
Commonly Associated Conditions
- Cholelithiasis, cholecystitis, cholangitis
- Gallstone pancreatitis
- Colorectal adenomas: Strong association between cholelithiasis and multiple (≥3) lesions (adjusted OR 2.39, 95% CI 1.21–4.72) and left-sided colorectal adenomas (adjusted OR 1.82, 95% CI 1.28–2.59) (3)[A]
- Cholangiocarcinoma (OR = 23.97, 95% CI 2.9–198.9) (4)[A]; cholecystectomy not preventative