title: Management and Outcome of Borderline Common Bile Duct with Stones: A Prospective Randomized Study.
abstract: BACKGROUND
  Management of common bile duct stones (CBDS) in patients with borderline CBD presents a surgical challenge. The aim of this study was to compare conservative treatment with endoscopic stone extraction for the treatment of borderline CBD with stones.
  
  
  METHODS
  This prospective randomized controlled trial includes patients with CBDS in borderline CBD (CBD <10 mm) associated with gallbladder stones who were treated with conservative treatment or endoscopic stone extraction followed by laparoscopic cholecystectomy (LC) and intraoperative cholangiogram (IOC). The primary outcome was successful CBD clearance. The secondary outcomes were the overall complications, cost, and hospital stay.
  
  
  RESULTS
  LC and IOC revealed complete clearance of CBDS in 48 (96%) cases in the endoscopic retrograde cholangiopancreatography (ERCP) group (52% of patients by ERCP, and 44% of patient passed the stone spontaneously), and in the remaining two patients, the CBDS was removed by transcystic exploration. In the conservative group, LC and IOC revealed complete clearance of CBDS in 90% of cases, and in the remaining 10% of patients, the CBDS was removed by transcystic exploration. Post-ERCP pancreatitis (PEP) is noticed significantly in the ERCP group (2 [4%] versus 8 [16%]; P = .04). The average net cost was significantly higher in the ERCP group. Recurrent biliary symptoms developed significantly in the ERCP group after 1 year (10% versus 0%; P = .02) in the form of recurrent cholangititis and recurrent CBDS.
  
  
  CONCLUSIONS
  Management of CBDS in patients with borderline CBD represents a surgical challenge. Borderline CBD increases the technical difficulty of ERCP and increases the risk of PEP. Conservative management of CBDS in borderline CBD not only avoids the risks inherent in ERCP and unnecessary preoperative ERCP, but it is also effective in clearing CBDS. The hepatobiliary surgeon should consider a conservative line of treatment in CBDS in borderline CBD in order to decrease the cost and avoid unnecessary ERCP.
authors.affiliation: Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt .
authors.forename: Ayman
authors.initials: A
authors.lastname: El Nakeeb
authors.affiliation: Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt .
authors.forename: Ahmed
authors.initials: A
authors.lastname: El Geidie
authors.affiliation: Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt .
authors.forename: Ehab
authors.initials: E
authors.lastname: El Hanafy
authors.affiliation: Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt .
authors.forename: Ehab
authors.initials: E
authors.lastname: Atef
authors.affiliation: Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt .
authors.forename: Waleed
authors.initials: W
authors.lastname: Askar
authors.affiliation: Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt .
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Sultan
authors.affiliation: Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt .
authors.forename: Emad
authors.initials: E
authors.lastname: Hamdy
authors.affiliation: Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt .
authors.forename: Mohamed
authors.initials: M
authors.lastname: El Shobary
authors.affiliation: Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt .
authors.forename: Hosam
authors.initials: H
authors.lastname: Hamed
authors.affiliation: Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt .
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdelrafee
authors.affiliation: Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt .
authors.forename: Mostafa Abu
authors.initials: MA
authors.lastname: Zeid
mesh_terms: D000293:Adolescent; D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult