Ice-breaking sign: A radiological sign influencing the treatment strategies for choledocholithiasis

doi:10.4240/wjgs.v17.i7.106712

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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

Retrospective Study

World J Gastrointest Surg. Jul 27, 2025; 17(7): 106712
Published online Jul 27, 2025. doi: 10.4240/wjgs.v17.i7.106712

Table 1 Baseline data

Baseline date		Control group	Case group	P value
Age (years)		45.0 (29.50-64.0)	47.0 (35.0-58.0)	0.689
Sex, n (%)	Male	30 (73.2)	33 (75.0)	1.000
Sex, n (%)	Female	11 (26.8)	11(25.0)	1.000
Height (cm)		170.0 (159.50-176.0)	171.0 (165.0-176.0)	0.178
Weight (kg), mean ± SD		68.60 ± 12.76	71.35 ± 18.89	0.533
BMI (kg/m²)		24.77 (23.04-25.81)	24.68 (22.22-26.81)	0.874

BMI: Body mass index.

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Table 2 Clinical manifestations, n (%)

Clinical manifestations	Classifications	Control group	Case group	P value
Abdominal pain	Yes	38 (92.7)	41 (93.2)	1.000
Abdominal pain	No	3 (7.3)	3 (6.8)	1.000
Fever	Yes	11 (26.8)	12 (27.3)	1.000
Fever	No	30 (73.2)	32 (72.7)	1.000
Jaundice	Yes	17 (41.5)	30 (68.2)	0.017
Jaundice	No	24 (58.5)	14 (31.8)	0.017
History of biliary tract disease	Yes	18 (43.9)	20 (45.5)	1.000
History of biliary tract disease	No	23 (56.1)	24 (54.5)	1.000
History of biliary surgery	Yes	7 (17.1)	9 (20.5)	0.785
History of biliary surgery	No	34 (82.9)	35 (79.5)	0.785

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Table 3 Laboratory indicators, mean ± SD

Laboratory indicators	Control group	Case group	P value
RBC (× 10¹²/L)	4.66 ± 0.48	4.70 ± 0.72	0.859
Hb (g/L)	139.75 ± 17.97	137.58 ± 24.0	0.127
WBC (× 10⁹/L)	7.99 (7.17-11.55)	7.19 (5.89-10.71)	0.075
PLT (× 10⁹/L)	228.0 (203.50-269.0)	223.0 (175.0-249.0)	0.926
N%	79.08 ± 12.05	79.90 ± 11.08	0.716
N (× 10⁹/L)	6.66 (4.86-10.06)	5.95 (4.35-5.95)	0.115
INR	1.13 (1.05-1.18)	1.18 (1.09-1.22)	0.062
ALT (U/L)	242.0 (134.0-434.0)	260.50 (162.0-525.0)	0.316
AST (U/L)	185.50 (74.0-387.0)	114.50 (61.0-515.0)	0.656
ALP (U/L)	181.0 (123.0-220.0)	182.0 (138.0-316.0)	0.007
TBIL (μmol/L)	60.95 (44.15-124.85)	112.35 (52.70-154.30)	0.025
TP (g/L)	78.43 ± 7.48	75.64 ± 9.83	0.957
ALB (g/L)	43.57 ± 4.96	40.99 ± 6.71	0.174
GGT (U/L)	440.50 (263.0-557.0)	357.0 (263.0-442.0)	0.180
CR (μmol/L)	66.50 (53.50-87.50)	62.0 (55.00 -80.0)	0.526
BUN (mmol/L)	4.00 (2.65-5.25)	3.06 (2.52-4.41)	0.181
UA (μmol/L)	300.50 (236.5-381.5)	254.0 (170.0-349.0)	0.071
AMY (U/L)	126.0 (87.50-772.50)	68.50 (55.0-82.0)	< 0.001

RBC: Red blood cell count; Hb: Hemoglobin; WBC: White blood cell count; PLT: Platelet count; N%: Neutrophil percentage; N: Neutrophil count; INR: International normalized ratio; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; TBIL: Total bilirubin; TP: Total protein; ALB: Albumin; GGT: Gamma-glutamyl transferase; CR: Creatinine; BUN: Blood urea nitrogen; UA: Uric acid; AMY: Amylase.

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Table 4 Surgery-related indicators, n (%)

Surgery-related information	Classifications	Control group	Case group	P value
ERCP success rate	Success	9 (81.8)	4 (25.0)	0.006
ERCP success rate	Fail	2 (18.2)	12 (75.0)	0.006
LCBDE success rate	Success	30 (93.8)	24 (69.4)	0.007
LCBDE success rate	Fail	2 (6.3)	13 (35.1)	0.007
Duration of surgery (minutes), mean ± SD	-	106.15 ± 35.21	148.04 ± 60.55	0.001
Surgical bleeding (mL)	-	10.0 (10.0-20.0)	25.0 (20.0-50.0)	< 0.001
T tube	Yes	10 (31.3)	23 (62.2)	0.016
T tube	No	22 (68.8)	14 (37.8)	0.016
Lithotripsy techniques	Yes	0	11(29.7)	0.001
Lithotripsy techniques	No	32 (100)	26 (70.3)	0.001
Length of hospital stay (days)	-	8.0 (6.0-11.50)	8.50 (7.0-12.0)	0.302
Length of postoperative hospital stay (days)	-	5.50 (3.0-6.50)	6.50 (5.0-9.0)	0.002

ERCP: Endoscopic retrograde cholangiopancreatography; LCBDE: Laparoscopic common bile duct exploration.

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Table 5 Radiological indices

Radiological indices	Classifications	Control group	Case group	P value
Percentage of narrowing of the proximal and distal bile duct	-	0% (0.0-20.54)	72.08% (62.50-77.78)	< 0.001
Intrahepatic bile duct dilation	Yes	37 (90.2)	43 (97.7)	0.192
Intrahepatic bile duct dilation	No	4 (9.8)	1 (2.3)	0.192
Proximal bile duct diameter (mm)	-	7.95 ± 2.76	11.65 ± 2.83	< 0.001
Distal bile duct diameter (mm)	-	9.0 (6.50-10.50)	3.0 (2.0-4.0)	< 0.001
Presence of a gallbladder	Yes	36 (87.8)	41 (93.2)	0.474
Presence of a gallbladder	No	5 (12.2)	3 (6.8)	0.474
Stone diameter (mm)	-	7.50 (6.0-8.0)	8.0 (6.0-10.0)	0.002

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Citation: Zhao XY, Chen M, Wang G, Cui L, Xu Z, Hou CS, Wang LX, Zhang LF, Ling XF. Ice-breaking sign: A radiological sign influencing the treatment strategies for choledocholithiasis. World J Gastrointest Surg 2025; 17(7): 106712
URL: https://www.wjgnet.com/1948-9366/full/v17/i7/106712.htm
DOI: https://dx.doi.org/10.4240/wjgs.v17.i7.106712