Natural History of Biliary Lithiasis

  • Grant Caddy


Biliary lithiasis is a common disease and is present in up to 20–30% of western populations. The prevalence increases with age, being <10% in populations under the age of 30 years and approximately 30% in those over the age of 60 [1]. This prevalence is similar in studies throughout Europe, including the UK. Owing to increasing life expectancy among patients throughout Europe, the prevalence of biliary lithiasis is also likely to increase. This review of the natural history of biliary lithiasis will deal with both choledocholithiasis (bile duct stones) and cholelithiasis (gallbladder stones).


Acute Pancreatitis Gallbladder Cancer Common Bile Duct Stone Bile Duct Stone Biliary Complication 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Heaton KW, Braddon FE, Mountford RA et al (1991) Symptomatic and silent gall stones in the community. Gut 32:316–320PubMedCrossRefGoogle Scholar
  2. 2.
    Johnson AG, Hosking SW (1987) Appraisal of the management of bile duct stones Br J Surg 74:555–560PubMedCrossRefGoogle Scholar
  3. 3.
    Saharia PC, Zuidema GD, Cameron JL (1977) Primary common duct stones. Ann Surg 185:598–604PubMedCrossRefGoogle Scholar
  4. 4.
    Kaufman HS, Magnuson TH, Lillemoe KD et al (1989) The role of bacteria in gallbladder and common duct stone formation. Ann Surg 209:584–591PubMedCrossRefGoogle Scholar
  5. 5.
    Cetta F (1991) The role of bacteria in pigment gallstone disease. Ann Surg 213:315–326PubMedCrossRefGoogle Scholar
  6. 6.
    Cetta FM (1986) Bile infection documented as initial event in the pathogenesis of brown pigment biliary stones. Hepatology 6:482–489PubMedCrossRefGoogle Scholar
  7. 7.
    Denbesten L, Doty JE (1981) Pathogenesis and management of choledocholithiasis. Surg Clin North Am 61:893–907PubMedGoogle Scholar
  8. 8.
    Glenn F, Beil AR Jr (1964) Choledocholithiasis demonstrated at 586 operations. Surg Gynecol Obstet 118:499–506PubMedGoogle Scholar
  9. 9.
    Glenn F, McSherry CK (1975) Calculous biliary tract disease. In: Ravitch MM (ed) Current problems in surgery. Yearbook Publishers, Chicago. pp 1–38Google Scholar
  10. 10.
    Joyce WP, Keane R, Burke GJ et al (1991) Identification of bile duct stones in patients undergoing laparoscopic cholecystectomy. Br J Surg 78:1174–1176PubMedCrossRefGoogle Scholar
  11. 11.
    Madden JL, Vanderheyden L, Kandalaft S (1968) The nature and surgical significance of common duct stones. Surg Gynecol Obstet 126:3–8PubMedGoogle Scholar
  12. 12.
    Castelain M, Grimaldi C, Harris AG et al (1993) Relationship between cystic duct diameter and the presence of cholelithiasis. Dig Dis Sci 38:2220–2224PubMedCrossRefGoogle Scholar
  13. 13.
    Taylor TV, Armstrong CP (1987) Migration of gall stones. Br Med J 294:1320–1322Google Scholar
  14. 14.
    Millbourn E (1941) Klinische Studien über die Choledochlithiasis. Acta Chir Scand 86 Suppl 65Google Scholar
  15. 15.
    Wenckert A, Robertson B (1966) The natural course of gallstone disease: eleven-year review of 781 nonoperated cases. Gastroenterology 50:376–381PubMedGoogle Scholar
  16. 16.
    Frossard JL, Hadengue A, Amouyal G et al (2000) Choledocholithiasis: a prospective study of spontaneous common bile duct stone migration. Gastrointest Endosc 51:175–177PubMedCrossRefGoogle Scholar
  17. 17.
    United States National Institutes of Health (2002) State-of-the-science statement on endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and therapy. NIH Consens State Sci Statements 19:1–26Google Scholar
  18. 18.
    Greiner L, Munks C, Heil W, Jakobeit C (1990) Gall bladder stone fragments in feces after biliary extracorporeal shock-wave lithotripsy. Gastroenterology 98:1620–1624PubMedGoogle Scholar
  19. 19.
    Oria A, Frider B, Alvarez J et al (1988) Biliary and pancreatic obstruction during gallstone migration. Int J Pancreatol 3:157–164PubMedGoogle Scholar
  20. 20.
    Festi D, Sottili S, Colecchia A et al (1999) Clinical manifestations of gallstone disease: evidence from the Multicenter Italian Study On Cholelithiasis (MICOL). Hepatology 30:839–846PubMedCrossRefGoogle Scholar
  21. 21.
    Anciaux ML, Pelletier G, Attali P et al (1986) Prospective study of clinical and biochemical features of symptomatic choledocholithiasis. Dig Dis Sci 31:449–453PubMedCrossRefGoogle Scholar
  22. 22.
    Katz D, Nikfarjam M, Sfakiotaki A Christophi C (2004) Selective endoscopic cholangiography for the detection of common bile duct stones in patients with cholelithiasis. Endoscopy 36:1045–1049PubMedCrossRefGoogle Scholar
  23. 23.
    Shiozawa S, Tsuchiya A, Kim DH et al (2005) Useful predictive factors of common bile duct stones prior to laparoscopic cholecystectomy for gallstones. Hepatogastroenterology 52:1662–1665PubMedGoogle Scholar
  24. 24.
    Alponat A, Kum CK, Rajnakova A et al (1997) Predictive factors for synchronous common bile duct stones in patients with cholelithiasis. Surg Endosc 11:928–932PubMedCrossRefGoogle Scholar
  25. 25.
    Onken JE, Brazer SR, Eisen GM et al (1996) Predicting the presence of choledocholithiasis in patients with symptomatic cholelithiasis. Am J Gastroenterol 91:762–767PubMedGoogle Scholar
  26. 26.
    Rijna H, Borgstein PJ, Meuwissen SG et al (1995) Selective preoperative endoscopic retrograde cholangiopancreatography in laparoscopic biliary surgery. Br J Surg 82:1130–1133PubMedCrossRefGoogle Scholar
  27. 27.
    Barkun AN, Barkun JS, Fried GM et al (1994) Useful predictors of bile duct stones in patients undergoing laparoscopic cholecystectomy. McGill Gallstone Treatment Group. Ann Surg 220:32–39PubMedCrossRefGoogle Scholar
  28. 28.
    Hauer-Jensen M, Karesen R, Nygaard K et al (1986) Consequences of routine peroperative cholangiography during cholecystectomy for gallstone disease: a prospective, randomized study. World J Surg 10:996–1002PubMedCrossRefGoogle Scholar
  29. 29.
    Thurston OG, McDougall RM (1976) The effect of hepatic bile on retained common duct stones. Surg Gynecol Obstet 143:625–627PubMedGoogle Scholar
  30. 30.
    Acosta JM, Ledesma CL (1974) Gallstone migration as a cause of acute pancreatitis. N Engl J Med 290:484–487PubMedGoogle Scholar
  31. 31.
    Acosta MJ, Rossi R, Ledesma CL (1977) The usefulness of stool screening for diagnosing cholelithiasis in acute pancreatitis. A description of the technique. Am J Dig Dis 22:168–172PubMedCrossRefGoogle Scholar
  32. 32.
    Kelly TR (1976) Gallstone pancreatitis: pathophysiology. Surgery 80:488–492PubMedGoogle Scholar
  33. 33.
    Crump C (1931) The incidence of gallstones and gallbladder disease. Surg Gynecol Obstet 53:447–457Google Scholar
  34. 34.
    Murison MS, Gartell PC, McGinn FP (1993) Does selective peroperative cholangiography result in missed common bile duct stones? J R Coll Surg Edinb 38:220–224PubMedGoogle Scholar
  35. 35.
    Caddy GR, Kirby J, Kirk SJ et al (2005) Natural history of asymptomatic bile duct stones at time of cholecystectomy. Ulster Med J 74:108–112PubMedGoogle Scholar
  36. 36.
    Collins C, Maguire D, Ireland A et al (2004) A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg 239:28–33PubMedCrossRefGoogle Scholar
  37. 37.
    O’Donovan AN, O’Sullivan G, Ireland A et al (1997) Prospective trial of the role of fine bore intubation of the cystic duct at the time of operative cholangiography. J Am Coll Surg 184:262–264PubMedGoogle Scholar
  38. 38.
    Wilson TG, Jeans PL, Anthony A et al (1993) Laparoscopic cholecystectomy and management of choledocholithiasis. Aust N Z J Surg 63:443–450PubMedCrossRefGoogle Scholar
  39. 39.
    Jolly PC, Baker JW, Schmidt HM et al (1968) Operative cholangiography: a case for its routine use. Ann Surg 168:551–565PubMedCrossRefGoogle Scholar
  40. 40.
    Pagana TJ, Stahlgren LH (1980) Indications and accuracy of operative cholangiography. Arch Surg 115:1214–1215PubMedGoogle Scholar
  41. 41.
    Faris I, Thomson JP, Grundy DJ, Le Quesne LP (1975) Operative cholangiography: a reappraisal based on a review of 400 cholangiograms. Br J Surg 62:966–972PubMedCrossRefGoogle Scholar
  42. 42.
    Adams JD, Haisten AS (1972) Operative cholangiography-its value in the unsuspected choledochal stone. Surg Clin North Am 52:333–340PubMedGoogle Scholar
  43. 43.
    Metcalfe MS, Ong T, Bruening MH et al (2004) Is laparoscopic intraoperative cholangiogram a matter of routine? Am J Surg 187:475–481PubMedCrossRefGoogle Scholar
  44. 44.
    United States National Institutes Of Health (1992) Gallstones and laparoscopic cholecystectomy. NIH Consens Statement 10:1–28Google Scholar
  45. 45.
    Moynihan BG (1908) An address on inaugural symptoms. Br Med J 2:1597–1601CrossRefGoogle Scholar
  46. 46.
    Mayo WJ (1911) “Innocent” gallstones a myth. JAMA 56:1021–1024Google Scholar
  47. 47.
    Comfort MW, Gray HK, Wilson JM (1948) The silent gallstone: a ten to twenty year follow-up study of 112 cases. Ann Surg 128:931–937CrossRefGoogle Scholar
  48. 48.
    Gracie WA, Ransohoff DF (1982) The natural history of silent gallstones: the innocent gallstone is not a myth. N Engl J Med 307:798–800PubMedCrossRefGoogle Scholar
  49. 49.
    Friedman GD, Raviola CA, Fireman B (1989) Prognosis of gallstones with mild or no symptoms: 25 years of follow-up in a health maintenance organization. J Clin Epidemiol 42:127–136PubMedCrossRefGoogle Scholar
  50. 50.
    Lund J (1960) Surgical indications in cholelithiasis: prophylactic cholecystectomy elucidated on the basis of long-term follow up on 526 nonoperated cases. Ann Surg 151:153–162PubMedCrossRefGoogle Scholar
  51. 51.
    Newman HF, Northup JD, Rosenblum M, Abrams H (1968) Complications of cholelithiasis. Am J Gastroenterol 50(6):476–496PubMedGoogle Scholar
  52. 52.
    McSherry CK, Ferstenberg H, Calhoun WF et al (1985) The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients. Ann Surg 202:59–63PubMedCrossRefGoogle Scholar
  53. 53.
    Ransohoff DF, Gracie WA (1993) Treatment of gallstones. Ann Intern Med 119:606–619PubMedGoogle Scholar
  54. 54.
    Attili AF, De Santis A, Capri R et al (1995) The natural history of gallstones: the Grepco experience. The Grepco Group. Hepatology 21:655–660PubMedCrossRefGoogle Scholar
  55. 55.
    Gurusamy KS, Samraj K (2007) Cholecystectomy versus no cholecystectomy in patients with silent gallstones. Cochrane Database Syst Rev Cd006230Google Scholar
  56. 56.
    Zubler J, Markowski G, Yale S et al (1998) Natural history of asymptomatic gallstones in family practice office practices. Arch Fam Med 7:230–233PubMedCrossRefGoogle Scholar
  57. 57.
    Thistle JL, Cleary PA, Lachin JM et al (1984) The natural history of cholelithiasis: the National Cooperative Gallstone Study. Ann Intern Med 101:171–175PubMedGoogle Scholar
  58. 58.
    Sakorafas GH, Milingos D, Peros G (2007) Asymptomatic cholelithiasis: is cholecystectomy really needed? a critical reappraisal 15 years after the introduction of laparoscopic cholecystectomy. Dig Dis Sci 52:1313–1325PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Grant Caddy
    • 1
  1. 1.Department of GastroenterologyUlster HospitalBelfastNorthern Ireland (G.B.)

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