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Canadian Journal of Gastroenterology and Hepatology
Volume 2019, Article ID 5382708, 5 pages
https://doi.org/10.1155/2019/5382708
Research Article

Parameters Suggesting Spontaneous Passage of Stones from Common Bile Duct: A Retrospective Study

1Department of Gastroenterology and Liver Disease, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
2Department of Surgery, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
3Department of Radiology, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
4Department of Surgery, Kaplan Medical Center, Rehovot, Israel
5Institute of Gastroenterology and Liver Diseases, Galilee Medical Center, Bar Ilan Faculty of Medicine, Israel

Correspondence should be addressed to Tawfik Khoury; moc.liamtoh@1yruohkkifwat

Received 26 September 2018; Accepted 12 February 2019; Published 3 March 2019

Academic Editor: Joseph Feuerstein

Copyright © 2019 Tawfik Khoury et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Common bile duct (CBD) stones are common. However, they are known to pass spontaneously, which obviates the need for ERCP. Aim. The aim of this study is to identify specific predictors for spontaneous passage of CBD stones. Methods. Data was retrospectively collected for all patients who were hospitalized with clinical, laboratory, or ultrasonographic evidence of choledocholithiasis and who underwent magnetic resonance cholangiopancreatography (MRCP) in Hadassah Medical Center between 2005 and 2011. The patients were classified into 4 groups: group A (positive MRCP and positive ERCP), group B (positive MRCP but negative ERCP), group C (positive MRCP but did not undergo ERCP), and group D (negative MRCP that did not undergo ERCP) for choledocholithiasis. All positive MRCP-groups (A+B+C) were further grouped together into group E. We compared groups A versus B and groups E versus D. Results. Comparing groups A versus B, only gamma-glutamyl transferase predicted spontaneous passage of stones from CBD, as the level was significantly higher in group A (677±12.1) versus group B (362.4±216.2) (P=0.023). Patients with small stone diameter (P=0.001), distal stones (P=0.05), and absence of intrahepatic dilatation (P=0.047) tend to pass their stones spontaneously. Comparing groups D versus E, it was found that male gender (P=0.03), older age (P<0.001), high levels of GGT (P=0.022), high levels of alkaline phosphatase (P=0.011), high levels of total bilirubin (P=0.007), and lower levels of amylase (P<0.001) are predictors for positive MRCP studies for CBD stones. Conclusion. Identification of specific predictors is important to avoid unnecessary invasive endoscopic intervention.