Korean J Gastroenterol.  2024 Dec;84(6):274-281. 10.4166/kjg.2024.099.

Clinical Features of Impacted Common Bile Duct Stones at Duodenal Papilla

• Lee JM
• Lee SH
• Kim JH
• Kim TS
• Chang SH
• Kim SH
• Lee JH
• Kang CD
• Park JM

• KMID: 2563344
• DOI: http://doi.org/10.4166/kjg.2024.099

Abstract

Background/Aims
Urgent endoscopic removal is required for gallstones impacted at the duodenal papilla. This study compared the clinical features of impacted papillary stones (IPS) with those of common bile duct stones without impaction.
Methods
This study analyzed a common bile duct stone database from 2017 to 2023, identifying patients with IPS. The clinical features of IPS were compared with those of common bile duct stones without IPS (NIPS).
Results
One hundred and eighty patients were analyzed; 45 had IPS. The mean age was 63.9 years, with a male predominance in the IPS group. The success rates of selective biliary cannulation were comparable between the IPS and NIPS groups. Multivariate analysis showed that IPS was associated with pancreatitis (odds ratio [OR] 3.78, 95% confidence interval [CI]: 1.17–12.17, p=0.026), bile duct penetrating duodenal wall sign (BPDS, OR 12.09, 95% CI: 3.92–37.33, p<0.001), and the presence of pus (OR 27.05, 95% CI: 4.92–148.85, p<0.001). The periampullary diverticulum (OR 0.28, 95% CI: 0.10–0.82, p=0.021) and the largest stone ≥10 mm (OR 0.31, 95% CI: 0.10–0.96, p=0.043) were inversely correlated with IPS.
Conclusions
IPS are associated with pancreatitis, BPDS, and acute suppurative cholangitis, whereas periampullary diverticulum and the stone size are inversely correlated with IPS.

Keyword

Gallstones; Common bile duct; Cholangiopancreatography, endoscopic retrograde; Ampulla of Vater; Pancreatitis

Figure

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  Fig. 1 Flow of subject inclusion. ERCP, endoscopic retrograde cholangiopancreatography; EST, endoscopic sphincterotomy.

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  Fig. 2 An 88-year-old female underwent ERCP for acute cholangitis. (A) An impacted gallstone was observed at the duodenal papilla. (B) Bile duct penetrating duodenal wall sign was visualized on coronal CT. The arrow indicates the impacted stone. (C) Needle knife fistulotomy was performed, resulting in the drainage of pus from the bile duct. (D) The impacted stone was removed. ERCP, endoscopic retrograde cholangiopancreatography.

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