Stone in bile duct (gallbladder already removed)

[poppyz]

This week my 65 year old mother had a laparoscopic cholecystectomy with per operative cholangiogram.  The gall bladder was removed sucessfully but there was an unsucessful attempt to remove one 5mm bile duct stone.  She has been adivised to have an ERCP and ES soon to remove this stone, but is absolutely terrified. We are so concerned at the seemingly high complication and mortality rate (especially pancreatitis).

Are there any non surgical interventions at all that could be tried to remove it instead(shockwave etc etc), in light of the fact that she doesnt now have a gallbladder?

Also, how much of a risk is a 5mm stone in the bile duct? Could it spontaneously pass? Is there a chance that now the gallblader is out, that the regular and painful biliary colic she was experiencing could resolve itself without the need to get the stone out the bile duct?

WE would be most grateful for advice on the options.
Thank you.
Poppy

[Kevin Pho, MD]

Surgeon has kindly answered your question in his comments below and I agree with his assessment.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[surgeon]

a stone in the bile duct has more potential danger than stones in the gallbladder, specifically pancreatitis and/or infection in the bile duct system. A 5 mm stone could indeed pass on its own; it's not possible to say with certainty. The fact is that the relative risk of the surgery was higher than that of ERCP. Complications can happen with any procedure, but in general ERCP is quite safe and it considered the most effective way to treat a bile duct stone. Alternatives include doing nothing in the hopes it will pass (but it can be hard to tell if it has, since the best way to image the duct is ERCP -- sonogram, for example, may or may not find a stone that's there); stones can be extracted by passing a wire through the liver, but it's not really safer than ERCP. And stone-dissolving pills can sometimes work. Finally, lithotripsy (smashing the stone with sonic waves) has been done for bile duct stones. Again, it's not free of side effects and risks. Without question, my approach to stones in the bile duct that couldn't be removed at operation is to have them removed by ERCP. Check out the list of possible complications from the surgery and anesthesia she already had: If you weren't terrified of that, you certainly shouldn't be terrified of ERCP.

[confetti]

I had ERCP  twice following gallbladder removal and had pancreatitis, liver function damage and severe jaundice.  I was sick for 5 months.  I'm much younger, 52 but have to say that the pain from the stone was worse than the gall bladder pain pre-surgery.  My ERCP was delayed for several days, not my choice and consequently my common bile duct became inflamed which caused bigger problems

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