Composition of common bile duct stones in Chinese patients during and after endoscopic sphincterotomy.
OBJECTIVE
Endoscopic sphincterotomy (ES) is a well-established therapeutic modality for the removal of common bile duct (CBD) stones. After ES there are still around 10% of patients that experience recurrent CBD stones. The aim of this study is to investigate the composition of CBD stones before and after ES and its clinical significance in Chinese patients.


METHODS
From January 1996 to December 2003, 735 patients with CBD stones received ES at Kaohsiung Veterans General Hospital and stone specimens from 266 patients were sent for analysis. Seventy-five patients had recurrent CBD stones and stone specimens from 44 patients were sent for analysis. The composition of the stones was analyzed by infrared (IR) spectrometry and they were classified as cholesterol or bilirubinate stones according to the predominant composition. Clinical data were analyzed.


RESULTS
In the initial 266 stone samples, 217 (82%) were bilirubinate stones, 42 (16%) were cholesterol stones, 3 were calcium carbonate stones, 4 were mixed cholesterol and bilirubinate stones. Patients with bilirubinate stones were significantly older than patients with cholesterol stones (66+/-13 years vs 56+/-17 years, P = 0.001). In the 44 recurrent stone samples, 38 (86%) were bilirubinate stones, 3 (7%) were cholesterol stones, and 3 were mixed cholesterol and bilirubinate stones. In 27 patients, both initial and recurrent stone specimens can be obtained, 23 patients had bilirubinate stones initially and 2 became cholesterol stones in the recurrent attack. In the four patients with initial cholesterol stones, three patients had bilirubinate stones and one patient had a cholesterol stone in the recurrent attack.


CONCLUSIONS
Bilirubinate stone is the predominant composition of initial or recurrent CBD stone in Chinese patients. The composition of CBD stones may be different from initial stones after ES.
Tsai
Wei-Lun
WL
Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, National Yang Ming University, Taiwan, China.
Lai
Kwok-Hung
KH
Lin
Chiun-Ku
CK
Chan
Hoi-Hung
HH
Lo
Ching-Chu
CC
Hsu
Ping-I
PI
Chen
Wen-Chi
WC
Cheng
Jin-Shiung
JS
Lo
Gin-Ho
GH
D000368:Aged; D001663:Bilirubin / Q000032:analysis / Q000378:metabolism*; D002784:Cholesterol / Q000032:analysis / Q000378:metabolism*; D005260:Female; D042882:Gallstones / Q000737:chemistry / Q000378:metabolism* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016717:Sphincterotomy, Endoscopic
D002784:Cholesterol; D001663:Bilirubin