Related Experiment Videos
Presence and density of common bile duct microlithiasis in acute biliary pancreatitis
Maciej Kohut1, Andrzej Nowak, Ewa Nowakowska-Duiawa
1Department of Gastroenterology, Central Clinical Hospital, Silesian Academy of Medicine, Medyk w 14,40 - 752 Katowice, Poland. maciej.2250177@pharmanet.com.pl
Aim:
Common bile duct microlithiasis (CBDM) is found in majority of patients with acute biliary pancreatitis (ABP) and no CBD stones in fluoroscopy during urgent ERCP. It is unclear, however, weather CBDM is a cause or the result of the disease. This prospective study was done to investigate the presence and density of CBDM in patients with ABP, when endoscopic retrograde cholangiopancreatography (ERCP) was done in different periods from the onset of the disease.
Methods:
One hundred fifty one consecutive patients with ABP and no CBDS on ERCP, performed as an urgent (< 24h of admission) procedure, (101 - with gallbladder stones, 50 post-cholecystectomy patients), treated during last 4 years were prospectively included to the study. The presence and density of CBDM (cholesterol monohydrate crystals-CMCs and calcium bilirubinate granules-CBGs) in bile collected directly from common bile duct during ERCP was prospectively calculated according to Juniper and Burson criteria. High density of crystals was considered,when we found >10CMCs and/or >25 clusters of CBGs on 1 slide.
Results:
CBD microlithiasis was present in given number of patients: on d1-30/34 (88.2%), on d2 41/49 (83.7%), on d3-23/33 (69.6%), on d4-7-24/35 (68.6%) ( P for trend=0.018). In patients with CBD microlithiasis the high density of crystals was observed in given number of patients:on d1-27/30 (90%), on d2-34/41 (82.9%), on d3-18/23 (78.3%), on d4-7-16/24 (66.7%)( P for trend=0.039).
Conclusion:
In patients with ABP and no CBDS on ERCP, CBD microlithiasis is observed in the majority of patients, especially during the first day of the disease. Density of CBD microlithiasis is the highest in the first day of the disease. This suggests that CBD microlithiasis can be the cause and not the result of ABP.
Insights
Common bile duct microlithiasis (CBDM) is frequently found in acute biliary pancreatitis (ABP) patients without stones. This study suggests CBDM may cause ABP, especially when detected early with high crystal density.
Area of Science:
- Gastroenterology
- Hepatology
- Biliary System Diseases
Background:
- Common bile duct microlithiasis (CBDM) is prevalent in acute biliary pancreatitis (ABP) patients lacking detectable CBD stones during ERCP.
- The etiological role of CBDM in ABP remains uncertain, with debate on whether it's a cause or consequence.
Purpose of the Study:
- To investigate the presence and density of CBDM in ABP patients.
- To assess how CBDM prevalence and crystal density vary with the time elapsed since disease onset.
Main Methods:
- Prospective study of 151 consecutive ABP patients without CBD stones on urgent ERCP.
- Bile analysis during ERCP to quantify cholesterol monohydrate crystals (CMCs) and calcium bilirubinate granules (CBGs).
- Defined high crystal density as >10 CMCs and/or >25 CBG clusters per slide.
Main Results:
- CBDM was detected in 88.2% on day 1-3, decreasing to 68.6% by day 4-7 (P=0.018).
- High crystal density was observed in 90% on day 1-3, reducing to 66.7% by day 4-7 (P=0.039).
- Both prevalence and density of CBDM were highest in the initial disease phase.
Conclusions:
- CBD microlithiasis is present in most ABP patients without common bile duct stones, particularly early in the disease course.
- The high prevalence and density of CBDM during the initial phase suggest it may be a causative factor in ABP rather than a result.