What tests are used to diagnose choledocholithiasis?
Blood tests may include:
Complete blood count (CBC).
Bilirubin test.
Pancreas function tests.
Liver function tests.
Imaging tests may include:
Abdominal ultrasound. An ultrasound is a simple and noninvasive test that can give some early clues about your condition. It can reveal gallstones in your gallbladder, if there are any. It doesn’t visualize the common bile duct as well, but it can show if your duct is dilated, which indicates a blockage. It may also show shadowing where the blockage is.
Endoscopic ultrasound This test combines ultrasound technology with an upper endoscopy exam for a clearer picture of your bile ducts. It involves passing a tiny lighted camera on a tube (endoscope) down your throat and into your upper gastrointestinal (GI) tract. An ultrasound probe on the end of the endoscope sends out sound waves to produce images of your biliary system.
MRCP. Magnetic resonance cholangiopancreatography (MRCP) is a type of MRI that specifically visualizes the bile ducts. It’s noninvasive and creates very clear images of your biliary system, including the common bile duct. Your provider might use this test first to find a suspected gallstone there. But if they’re already pretty sure it’s there, they might go straight to an ERCP.
ERCP. ERCP stands for endoscopic retrograde cholangiopancreatography. This test is a little more invasive, but it’s a useful one for finding gallstones because it can also be used to remove them. It combines X-rays and endoscopy. When the endoscope reaches the top of your small intestine, your technician slides another, smaller tube into the first one to reach farther down into your bile ducts. They inject a special dye through the tube and then take video X-rays (fluoroscopy) as the dye travels through your ducts. When they find stones, they can treat them.
MANAGEMENT AND TREATMENT
How do doctors remove gallstones in the common bile duct?
They usually remove them during an ERCP exam. Doctors can attach special tools to the endoscope to break up and remove the stones when they find them. Sometimes, they make a surgical cut into the muscle of the duct to open it up and allow stones to pass. This is called a sphincterotomy.
Does choledocholithiasis require surgery?
The endoscopic procedure (ERCP) doesn’t require cutting into your abdomen to access the bile ducts. However, after removing gallstones from your bile ducts, doctors often recommend surgery to remove your gallbladder. This is to prevent more gallstones from exiting your gallbladder and causing choledocholithiasis again.
Will I need any other treatments?
Depending on your condition, you may need treatment before your gallstones can be removed, such as:
Antibiotics to treat infection.
Biliary drainage to remove backed-up bile.
What are the complications of the treatment?
Short-term complications of endoscopic gallstone removal may include:
Bleeding.
Infection.
Pancreatitis.
Long-term complications after treatment may include:
Gallstone recurrence. Even after removing all the gallstones in your bile ducts, it’s possible for new ones to form there later on. People who have had them are more likely to get them again.
Bile duct fibrosis. Cutting into your bile duct can cause scarring of the tissue, and sometimes, scar tissue causes the passageway to narrow (biliary stricture). This can cause a different kind of obstruction in the common bile duct. It may require another procedure to treat it.
PREVENTION
Can choledocholithiasis be prevented?
As cholesterol gallstones are the most common type, you may be able to reduce your risk by reducing cholesterol in your blood through dietary and lifestyle changes. Healthcare providers also recommend that you avoid “yo-yo” dieting and lose weight gradually. Losing too quickly can encourage gallstones.
OUTLOOK / PROGNOSIS
What is the prognosis after treatment for choledocholithiasis?
Treatment is simple and effective for most people. If you’re among the few who have complications afterward, these complications are also treatable. Between 5% and 25% of people may develop new gallstones in their bile ducts within 10 to 20 years. The risk is less if you have your gallbladder removed.