Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
J Gastroenterol. 2020 Jan;55(1):78-85. doi: 10.1007/s00535-019-01612-7. Epub 2019 Aug 31.
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.
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.
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).
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.
由于腹部影像学检查机会的增加，胆管结石偶尔在没有任何症状的情况下被诊断出来。然而，对于无症状胆管结石的处理尚无共识。我们进行了一项回顾性纵向队列研究，旨在调查无症状胆管结石的自然史，并根据内镜取石的时机研究临床结局。
我们确定了连续诊断为无症状胆总管结石的患者，并将其分为结石原位（观察等待组）和早期内镜取石（干预组）。估计并比较两组患者胆道并发症的累积发生率。
共纳入 191 例患者（观察等待组 114 例，干预组 77 例）。在观察等待组中，1 年、3 年和 5 年时的胆道并发症累积发生率分别为 6.1%、11%和 17%。22 例（19%）患者无症状结石消失。无症状结石早期内镜取石的相关不良事件发生在 25 例（32%）患者中，包括 4 例（5.2%）严重胰腺炎。治疗策略的累积胆道并发症发生率无差异（P=0.55）。
无症状胆管结石患者发生胆道并发症的比例较高，但早期内镜取石似乎对预防进一步的胆道并发症没有影响。鉴于与操作相关的胰腺炎风险，观察等待策略可能成为无症状结石的一种管理选择。
