Zang YF, Xing YX, Sun NZ. Evaluating the role of magnetic resonance cholangiopancreatography in therapeutic decision-making for difficult common bile duct stones. World J Gastrointest Surg 2025; 17(11): 112341 [DOI: 10.4240/wjgs.v17.i11.112341]
Corresponding Author of This Article
Nian-Zhe Sun, MD, National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Kaifu District, Changsha 410008, Hunan Province, China. sunnzh201921@sina.com
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Gastroenterology & Hepatology
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Letter to the Editor
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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/
Nov 27, 2025 (publication date) through Nov 25, 2025
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World Journal of Gastrointestinal Surgery
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1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Zang YF, Xing YX, Sun NZ. Evaluating the role of magnetic resonance cholangiopancreatography in therapeutic decision-making for difficult common bile duct stones. World J Gastrointest Surg 2025; 17(11): 112341 [DOI: 10.4240/wjgs.v17.i11.112341]
World J Gastrointest Surg. Nov 27, 2025; 17(11): 112341 Published online Nov 27, 2025. doi: 10.4240/wjgs.v17.i11.112341
Evaluating the role of magnetic resonance cholangiopancreatography in therapeutic decision-making for difficult common bile duct stones
Yu-Fang Zang, Yi-Xuan Xing, Nian-Zhe Sun
Yu-Fang Zang, Xiangya Cancer Center, and Center for Molecular Oncology and Immunology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
Yu-Fang Zang, Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
Yu-Fang Zang, Nian-Zhe Sun, National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
Yi-Xuan Xing, Department of Emergency Medicine, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Nian-Zhe Sun, Department of Orthopedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
Co-corresponding authors: Yi-Xuan Xing and Nian-Zhe Sun.
Author contributions: Zang YF wrote the first draft, developed the main ideas, and led revisions of the manuscript. Sun NZ and Xing YX spearheaded the conception and design of the study, provided critical revisions, and were integral to the manuscript’s final structure. Both Sun NZ and Xing YX made crucial and indispensable contributions to data interpretation and manuscript preparation, which qualify them as co-corresponding authors. Sun NZ conceptualized and supervised the entire project process, and was responsible for overseeing the literature review, revising, and submitting early versions of the manuscript. Xing YX played an essential role in data analysis and re-interpretation of results, and took the lead in preparing the final version of the manuscript, focusing on integrating the study’s findings into the broader context of difficult common bile duct stones. Their collaboration was vital for the success of this study and the manuscript’s completion.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for 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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nian-Zhe Sun, MD, National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Kaifu District, Changsha 410008, Hunan Province, China. sunnzh201921@sina.com
Received: July 24, 2025 Revised: August 30, 2025 Accepted: October 10, 2025 Published online: November 27, 2025 Processing time: 124 Days and 15 Hours
Abstract
This letter presents a critical analysis of the study by Zhao et al, which proposed a therapeutic strategy for difficult common bile duct stones focusing on the "ice-breaking sign" as a pivotal radiological feature. Based on magnetic resonance cholangiopancreatography with three-dimensional reconstruction, the diagnostic criteria for this sign were established by identifying an abrupt narrowing at the distal bile duct caused by impacted stones, analogous to the morphology of an ice-breaking vessel. Specifically, the proximal bile duct (hepatic hilar side) exhibited significant dilatation upstream of the stenosis, while the distal segment (duodenal papillary side) presented with stricture or occlusion. This study was the first to introduce the radiological marker termed the "ice-breaking sign", providing a novel dimension for the evaluation of refractory common bile duct stones. However, notable limitations were also present in this study. The interpretation of the ice-breaking sign depended largely on subjective assessments by physicians, even though a multidisciplinary consensus approach was employed. Objective quantification criteria, such as specific thresholds for the degree of stenosis, were not established. Furthermore, being a single-center study, it might have influenced the reproducibility of findings across different centers. Future studies should explore the pathophysiological mechanisms of the "ice-breaking sign" in greater depth, increase the sample size, and conduct multicenter research to validate its clinical universality and guiding significance for treatment strategies.
Core Tip: This letter analyzes Zhao et al’s study, introducing the "ice-breaking sign" as a new radiological marker for difficult common bile duct stones. Identified via magnetic resonance cholangiopancreatography (MRCP) with three-dimensional reconstruction, this sign highlights an abrupt distal narrowing with proximal dilation, reflecting changes in bile dynamics due to stone impaction. While this marker offers valuable insights for treatment planning, the study's limitations include reliance on subjective assessments and being single-center. Future research should focus on the sign’s pathophysiological mechanisms, validate findings through multicenter trials, and explore combining MRCP with endoscopic ultrasound and biological markers to optimize treatment strategies.
