Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website http://www.gastrores.org

Original Article

Volume 6, Number 6, December 2013, pages 219-226

Common Bile Duct Dilatation With Stones Indicates Requirement for Early Drainage in Patients With or Without Cholangitis

Figure

Figure 1.
Figure 1. Study flow chart for treatment of patients with common bile duct stones.

Tables

Table 1. Diagnostic Criteria for Acute Cholangitis
 
Definite diagnosis: one item in A, one item in B and one item in C.
ASystemic inflammation
A-1  Fever and/or shaking chills
A-2  Laboratory data: evidence of inflammatory response
BCholestasis
B-1  Jaundice
B-2  Laboratory data: evidence of abnormal liver function tests
CImaging
C-1  Biliary dilation
C-2  Evidence of the etiology on imaging

 

Table 2. Severity Assessment Criteria for Acute Cholangitis
 
STD, lower limit of normal value.
Grade III (severe) acute cholangitis
Grade III acute cholangitis is defined as acute cholangitis that is associated with the onset of dysfunction in at least one of any of the following organs/systems:
  1. Cardiovascular dysfunction: hypotension requiring dopamine ≥ 5 µg/kg/min, or any dose of norepinephrine
  2. Neurologic dysfunction: disturbance of consciousness
  3. Respiratory dysfunction: PaO2/FiO2 ratio < 300
  4. Renal dysfunction: oliguria, serum creatine > 2.0 mg/dL
  5. Hepatic dysfunction: PT-INR > 1.5
  6. Hematologic dysfunction: platelet count < 100,000/mm3
Grade II (moderate) acute cholangitis
Grade II acute cholangitis is associated with any two of following conditions:
  1. Abnormal WBC count (> 12,000/mm3, < 4,000/mm3)
  2. High fever (≥ 39 °C)
  3. Age (≥ 75 years old)
  4. Hyperbilirubinemia (total bilirubin ≥ 5 mg/dL)
  5. Hypoalubuminemia (< STD x 0.7)
Grade I (mild) acute cholangitis
Grade I acute cholangitis does not meet the criteria of Grade III or Grade II acute cholangitis at initial diagnosis.

 

Table 3. Characteristics of Patients With CBD Stones Who Required and Did Not Require Emergent Drainage
 
N = 101Emergent drainage required (N = 32)No emergent drainage required (N = 69)P value
CBD, common bile duct; EST, endoscopic sphincterotomy.
Patient (M/F)32 (18/14)69 (37/32)0.81
Smoking16280.37
Alcohol13290.89
Diabetes9130.29
Gallstone14460.029
CBD dilation25330.004
No. of CBD stones > 217350.82
Size of CBD stones > 10 mm17200.019
History of EST670.23
Periampullary diverticlum16220.58

 

Table 4. Multivariate Analysis of Risk Factors for Cholangitis Requiring Emergent Drainage
 
OR (95% CI)P value
CBD, common bile duct; OR, odds ration; CI, confidence interval.
CBD dilation3.75 (1.41-9.96)0.008
Gallstone2.44 (0.997-5.952)0.051
Size of CBD stones > 10 mm1.58 (0.59-4.23)0.36

 

Table 5. Univariate Analysis of Risk Factors for Development of Severe or Moderate Cholangitis in Patients With Silent CBD Stones
 
N = 35Emergent treatment (N = 8)Scheduled treatment (N = 27)P value
CBD, common bile duct.
Patient (M/F)8 (5/3)27 (17/10)0.65
Smoking6150.29
Alcohol5130.38
Diabetes360.33
Gallstone3160.25
CBD dilation7110.025
No. of CBD stones > 26120.13
Size of CBD stones > 10 mm490.33
Elevation of AST or ALT4150.55
Elevation of ALP or γ-GTP5200.41

 

Table 6. Multivariate Analysis of Risk Factors for Development of Severe or Moderate Cholangitis in Patients With Silent CBD Stones
 
OR (95% CI)P value
CBD, common bile duct; OR, odds ration; CI, confidence interval.
CBD dilation10.18 (1.09-94.73)0.042
No. of CBD stones > 23.89 (0.58-26.12)0.13