7Epidemiology, pathogenesis, and classiﬁcationof biliary stones (common bile ductand intrahepatic)
Professor and Chairman
Department of General Medicine and Clinical Pharmacotherapeutics, Hiroshima University Hospital and Graduate School of Biomedical Sciences, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan
Gallstones are common in Western countries and Japan. Most gallstones are found in the gall-bladder, but they sometimes pass through the cystic duct into extrahepatic and/or intrahepaticbile ducts to become bile-duct stones, causing conditions known as choledocholithiasis and hep-atolithiasis. Some 10
15% of gallstone patients concomitantly suffer from bile-duct stones. Bile-duct stones can also be formed in the absence of gallbladder stones, and such primary bile-ductstones are more common in East Asian countries than in the Western world. Thus pathogenesisof primary and secondary bile-duct stones is unlikely to be similar. Furthermore, the gallbladderstones are primarily cholesterol or black-pigment stones, whereas most bile-duct stones arebrown-pigment stones (calcium bilirubin stones). Thus, epidemiology, pathogenesis and classiﬁ-cation of biliary stones are very likely to differ according to stone location (intrahepatic and/orextrahepatic bile duct).
choledocholithiasis; hepatolithiasis; cholesterol gallstone; pigment gallstone; bileinfection; bile stasis.
COMMON-BILE-DUCT STONESIncidence and distribution
Gallstones are extremely common in Western societies and also in Japan. Approxi-mately l5% of the American population is foundto have gallstones, and over 0.7 millioncholecystectomies are performed every year.
Of these, 10
15% cases are found tohave concomitant common-bile-duct (CBD) stones, but in the Western world few
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2006 Elsevier Ltd. All rights reserved.Best Practice & Research Clinical GastroenterologyVol. 20, No. 6, pp. 1075