Risk Factors for Development of Complications by Untreated Common Bile
Duct Stones: A Cross-Sectional Observation Study
Abstract
Background It is recommended by the latest guidelines that common bile
duct stones (CBDSs) should be removed, preferentially endoscopically,
regardless of the presence of symptoms or complications. However, it may
not be feasible due to very-old age and/or co-morbidities or rejected by
patients. Aim We aimed to identify factors for development of
complications after diagnosis of CBDSs to select vulnerable patients for
whom removal of CBDSs should be performed despite of risks. Methods
Medical records of patients with radiologically-confirmed CBDSs between
October 2005 and September 2019 were retrospectively analyzed. Results
Among a total of 634 consecutive patients, complications, defined as
obstructive jaundice, biliary pancreatitis, or acute cholangitis, were
already present in 416 (65.6%) at the time of diagnosis of CBDSs and
developed in 95 (15.0%) afterwards. Forty four (6.9%) patients
remained silent with the median follow-up periods of 31.5 months. With
multivariate analyses, untreatment within 1 month and the size of CBDSs
> 5 mm turned out to be independent risk factors for
development of complications. Spontaneous passage of CBDSs was confirmed
radiologically in 9 (11.1%) out of 81 patients untreated within 1
month. Conclusions CBDSs should be removed within 1 month from the
diagnosis, even in unsuitable patients, especially if the size exceeds 5
mm.