Division of Hepatology and Gastroenterology, Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
Tokai J Exp Clin Med. 2022 Sep 20;47(3):143-148.
Endoscopic removal is recommended for common bile duct stones (CBDs). However, in patients with asymptomatic CBDs, follow-up without treatment may be recommended because of the increased complication risks associated with asymptomatic CBDs removal. The objective of our study was to investigate the efficacy and safety of CBDs removal in asymptomatic patients.
Consecutive patients with naive papilla who underwent endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of CBDs from April 2016 to August 2020 were retrospectively analyzed. We compared the efficacy and safety of CBDs removal in asymptomatic and symptomatic patients.
We enrolled 300 patients, 53 asymptomatic and 247 symptomatic patients. Endoscopic CBDs removal was successful in all patients, except one symptomatic patient. However, the complete stone removal rate in a single session was significantly higher in the asymptomatic group than that in the symptomatic group. ERCP-related complications did not differ between the asymptomatic and symptomatic patients. The incidence of post-ERCP pancreatitis was similar and liver cirrhosis was the only significant risk factor for pancreatitis.
Complication risks associated with endoscopic CBDs removal was not significantly different between asymptomatic and symptomatic patients. Liver cirrhosis was a significant risk factor of ERCP-related pancreatitis.
推荐采用内镜方法去除胆总管结石（CBDs）。然而，对于无症状 CBDs 患者，由于与无症状 CBDs 取石相关的并发症风险增加，可能会建议不进行治疗而进行随访。本研究旨在探讨无症状患者 CBDs 取石的疗效和安全性。
回顾性分析 2016 年 4 月至 2020 年 8 月因 CBDs 行内镜逆行胰胆管造影术（ERCP）治疗的初治乳头患者的连续病例。我们比较了无症状和有症状患者 CBDs 取石的疗效和安全性。
共纳入 300 例患者，53 例无症状，247 例有症状。除 1 例有症状患者外，所有患者均成功进行了内镜 CBDs 取石，但无症状组单次取石的完全清除率明显高于有症状组。无症状和有症状患者的 ERCP 相关并发症无差异。胰腺炎的发生率相似，肝硬化是胰腺炎的唯一显著危险因素。
无症状和有症状患者内镜 CBDs 取石的并发症风险无显著差异。肝硬化是 ERCP 相关胰腺炎的显著危险因素。
