title: Common Bile Duct Dilatation With Stones Indicates Requirement for Early Drainage in Patients With or Without Cholangitis.
abstract: BACKGROUND
  Some patients with common bile duct (CBD) stones develop cholangitis requiring drainage, while others do not. The aims of this study were to elucidate the clinical differences among patients with CBD stones who required and did not require emergent drainage, and to identify risk factors for the development of cholangitis requiring emergent drainage in patients with silent CBD stones.
  
  
  METHODS
  Clinical characteristics of consecutive patients with CBD stones who underwent endoscopic removal of stones or biliary drainage were analyzed retrospectively.
  
  
  RESULTS
  Of 101 patients analyzed, 32 had moderate or severe cholangitis as the indication for emergent drainage, and the remaining 69 did not. Patients who required emergent drainage were more likely to have gallstones (P = 0.029), dilated CBD (> 10 mm) (P = 0.004) and larger CBD stones (P = 0.019). By multivariate analysis, CBD dilation was the only significant differentiating clinical characteristic of the patients who required emergent drainage (OR = 3.75, 95% CI: 1.41-9.96, P = 0.008). Of the 35 patients with silent bile duct stones, eight required emergent endoscopic drainage during the waiting period. CBD dilation was also the only significant risk factor for the development of moderate or severe cholangitis among patients with silent bile duct stones (OR = 10.18, 95% CI: 1.09-94.73, P = 0.042).
  
  
  CONCLUSIONS
  Dilated CBD (> 10 mm) was the only risk factor identified for requirement of early drainage in patients with CBD stones. Those who have silent CBD stones with CBD dilatation should undergo early drainage.
authors: Second Department of Internal Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama city, Wakayama 641-0012, Japan.
authors: Yasunobu
authors: Y
authors: Yamashita
authors: Second Department of Internal Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama city, Wakayama 641-0012, Japan.
authors: Kazuki
authors: K
authors: Ueda
authors: Second Department of Internal Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama city, Wakayama 641-0012, Japan.
authors: Hiroko
authors: H
authors: Abe
authors: Second Department of Internal Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama city, Wakayama 641-0012, Japan.
authors: Takashi
authors: T
authors: Tamura
authors: Second Department of Internal Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama city, Wakayama 641-0012, Japan.
authors: Masahiro
authors: M
authors: Itonaga
authors: Second Department of Internal Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama city, Wakayama 641-0012, Japan.
authors: Takeichi
authors: T
authors: Yoshida
authors: Second Department of Internal Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama city, Wakayama 641-0012, Japan.
authors: Hiroki
authors: H
authors: Maeda
authors: Second Department of Internal Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama city, Wakayama 641-0012, Japan.
authors: Takao
authors: T
authors: Maekita
authors: Second Department of Internal Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama city, Wakayama 641-0012, Japan.
authors: Mikitaka
authors: M
authors: Iguchi
authors: Second Department of Internal Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama city, Wakayama 641-0012, Japan.
authors: Hideyuki
authors: H
authors: Tamai
authors: Second Department of Internal Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama city, Wakayama 641-0012, Japan.
authors: Masao
authors: M
authors: Ichinose
authors: Second Department of Internal Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama city, Wakayama 641-0012, Japan.
authors: Jun
authors: J
authors: Kato
keywords: Acute cholangitis; Biliary drainage; Common bile duct stones