Saito H, Kadono Y, Shono T, Kamikawa K, Urata A, Nasu J, Imamura H, Matsushita I, Tada S. Remaining issues of recommended management in current guidelines for asymptomatic common bile duct stones. World J Gastroenterol 2021; 27(18): 2131-2140 [PMID: 34025069 DOI: 10.3748/wjg.v27.i18.2131]
Corresponding Author of This Article
Hirokazu Saito, MD, Doctor, Department of Gastroenterology, Kumamoto City Hospital, 4-1-60, Higashimachi, Higashi-ku, Kumamoto City 862-8505, Japan. arnestwest@yahoo.co.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hirokazu Saito, Shuji Tada, Department of Gastroenterology, Kumamoto City Hospital, Kumamoto City 862-8505, Japan
Yoshihiro Kadono, Department of Gastroenterology, Tsuruta Hospital, Kumamoto City 862-0925, Japan
Takashi Shono, Ikuo Matsushita, Department of Gastroenterology, Kumamoto Chuo Hospital, Kumamoto City 862-0965, Japan
Kentaro Kamikawa, Atsushi Urata, Haruo Imamura, Department of Gastroenterology, Saiseikai Kumamoto Hospital, Kumamoto City 861-4193, Japan
Jiro Nasu, Department of Gastroenterological Surgery, Kumamoto Chuo Hospital, Kumamoto City 862-0965, Japan
Author contributions: Saito H, Kadono Y, Shono T, Kamikawa K, Urata A, Nasu J, Imamura H, Matsushita I and Tada S have been involved equally and have read and approved the final manuscript; Saito H, Kadono Y, Shono T, Kamikawa K, Urata A, Nasu J, Imamura H, Matsushita I and Tada S meet the criteria for authorship established by the International Committee of Medical Journal Editors and verify the validity of the results reported.
Conflict-of-interest statement: There are no conflicts of interest to declare in relation to this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hirokazu Saito, MD, Doctor, Department of Gastroenterology, Kumamoto City Hospital, 4-1-60, Higashimachi, Higashi-ku, Kumamoto City 862-8505, Japan. arnestwest@yahoo.co.jp
Received: February 12, 2021 Peer-review started: February 12, 2021 First decision: March 28, 2021 Revised: April 1, 2021 Accepted: April 21, 2021 Article in press: April 21, 2021 Published online: May 14, 2021 Processing time: 87 Days and 1.4 Hours
Abstract
Current guidelines for treating asymptomatic common bile duct stones (CBDS) recommend stone removal, with endoscopic retrograde cholangiopancreatography (ERCP) being the first treatment choice. When deciding on ERCP treatment for asymptomatic CBDS, the risk of ERCP-related complications and outcome of natural history of asymptomatic CBDS should be compared. The incidence rate of ERCP-related complications, particularly of post-ERCP pancreatitis for asymptomatic CBDS, was reportedly higher than that of symptomatic CBDS, increasing the risk of ERCP-related complications for asymptomatic CBDS compared with that previously reported for biliopancreatic diseases. Although studies have reported short- to middle-term outcomes of natural history of asymptomatic CBDS, its long-term natural history is not well known. Till date, there are no prospective studies that determined whether ERCP has a better outcome than no treatment in patients with asymptomatic CBDS or not. No randomized controlled trial has evaluated the risk of early and late ERCP-related complications vs the risk of biliary complications in the wait-and-see approach, suggesting that a change is needed in our perspective on endoscopic treatment for asymptomatic CBDS. Further studies examining long-term complication risks of ERCP and wait-and-see groups for asymptomatic CBDS are warranted to discuss whether routine endoscopic treatment for asymptomatic CBDS is justified or not.
Core Tip: Current guidelines recommend endoscopic stone removal for asymptomatic common bile duct stones (CBDS). However, the risks of endoscopic retrograde cholangiopancreatography (ERCP)-related complication and natural history outcome of asymptomatic CBDS should be compared to decide on endoscopic treatment by ERCP. ERCP for asymptomatic CBDS reportedly has a high risk of ERCP-related complications; post-ERCP pancreatitis risk being the most common. The long-term natural history of asymptomatic CBDS is not well known. Further studies examining long-term complication risks of ERCP and wait-and-see groups for asymptomatic CBDS are warranted to evaluate whether routine endoscopic stone removal for asymptomatic CBDS is justified or not.
