Staging

Very strong predictors Strong predictors Moderate predictors

• Serum bilirubin > 4 • Serum bilirubin 1,8—4 • Age > 55 years
mg/dL mg/dL • Abnormal liver
• Presence of CBD stone • A dilated bile duct on biochemical test other
on transabdominal ultrasound than bilirubin
ultrasound • Clinical gallstone
• Clinical features of pancreatitis
acute cholangitis

High Risk Moderate Risk Low Risk

• At least 1 very strong • One strong predictors • No predictors
predictor and/or and/or
• 2 strong predictors • At least 1 moderate
predictor

American Society for Gastrointerstinal Endoscopy

(Choledocholithiasis patients stratify)
 Etiology
• Choledocholithiasis occurs as result of either:
formation of stones in the CBD or the passage
of gallstone that are formed in the gallbladder
into the CDB

Factors lead to formation

of stones

Bile stasis, bactibilia, chemical imbalances, ↑bilirubin

excretion, pH imbalances, formation of sludge

McNicoli Christopher F. Choledocholithiasis. 2021

University of New Mexico
Less commonly, stones are formed in the
intrahepatic biliary tree (Hepatolithiasis) and
may lead to choledocholithiasis
Gallstones are differentiated by their
composition.
• (75% incidence) Cholesterol stones: mainly
cholesterol
• Black pigment stones: pigment
• Brown pigment stones: mix of pigment & bile
lipids