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Natural history of asymptomatic bile duct stones and association of endoscopic treatment with clinical outcomes

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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Authors and Affiliations

  1. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Ryunosuke Hakuta, Tsuyoshi Hamada, Yousuke Nakai, Hiroki Oyama, Sachiko Kanai, Tatsunori Suzuki, Tatsuya Sato, Kazunaga Ishigaki, Kei Saito, Tomotaka Saito, Naminatsu Takahara, Suguru Mizuno, Hirofumi Kogure, Takeshi Tsujino, Minoru Tada, Hiroyuki Isayama & Kazuhiko Koike

  2. Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Takeyuki Watadani & Osamu Abe

  3. Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan

    Hiroyuki Isayama

Authors
  1. Ryunosuke Hakuta
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  2. Tsuyoshi Hamada
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  3. Yousuke Nakai
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  5. Sachiko Kanai
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  6. Tatsunori Suzuki
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  19. Kazuhiko Koike
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Contributions

RH, TH, and YN: conception and design of the study, analysis, and interpretation of the data, and drafting of the article. HO, SK, TS, TS, KI, KS, TS, NT, SM, HK, TW, TT, MT, OA, HI, and KK: critical revision of the article for important intellectual content. All authors: final approval of the article.

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Correspondence to Yousuke Nakai.

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Hakuta, R., Hamada, T., Nakai, Y. et al. Natural history of asymptomatic bile duct stones and association of endoscopic treatment with clinical outcomes. J Gastroenterol 55, 78–85 (2020). https://doi.org/10.1007/s00535-019-01612-7

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  • DOI: https://doi.org/10.1007/s00535-019-01612-7

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