# Choledocholithiasis — GCMD Library living collection

Everything in the library about choledocholithiasis — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 31 cited statements

## Episodes
### Evidence & Research
- [Transcystic Laparoscopic Common Bile Duct Exploration for Pediatric Patients with Choledocholithiasis](https://qa.library.globalcastmd.com/watch/transcystic-laparoscopic-common-bile-duct-exploration-for-pediatric-patients-with-choledocholithiasis-8558) — video · 1:04 · [machine version](https://qa.library.globalcastmd.com/watch/transcystic-laparoscopic-common-bile-duct-exploration-for-pediatric-patients-with-choledocholithiasis-8558.md)
- [Multi-Institutional Analysis of Choledocholithiasis in Pediatric vs Adult Patients](https://qa.library.globalcastmd.com/watch/multi-institutional-analysis-of-choledocholithiasis-in-pediatric-vs-adult-patients-10122) — video · 0:59 · [machine version](https://qa.library.globalcastmd.com/watch/multi-institutional-analysis-of-choledocholithiasis-in-pediatric-vs-adult-patients-10122.md)

### In-Depth Reviews
- [Choledocholithiasis with Drs. David Vitale & Lucas Neff](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884) — podcast · 15:27 · [machine version](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/transcystic-laparoscopic-common-bile-duct-exploration-for-pediatric-patients-with-choledocholithiasis-8558?t=0) Study Overview: Transcystic Laparoscopic CBD Exploration vs ERCP (Ep 1)
- [0:04](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=4) Introduction and Risk Factors for Choledocholithiasis (Ep 2)
- [1:15](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=75) Case Presentation and Risk Stratification (Ep 2)
- [3:34](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=214) Treatment Options: ERCP vs Laparoscopic Exploration (Ep 2)
- [5:07](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=307) Surgery-First Paradigm with Intraoperative Cholangiography (Ep 2)
- [7:41](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=461) Technical Details of Laparoscopic Common Bile Duct Exploration (Ep 2)
- [11:20](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=680) Safety Considerations and Learning Curve (Ep 2)
- [13:48](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=828) Summary and Key Takeaways (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/multi-institutional-analysis-of-choledocholithiasis-in-pediatric-vs-adult-patients-10122?t=0) Surgery-First Approach for Pediatric Choledocholithiasis (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Dantes et al. performed a multi-center retrospective review of pediatric and adult patients treated for choledocholithiasis between 2018 and 2024" — Alex Halpern (epidemiological) [Ep 3 · 0:11](https://qa.library.globalcastmd.com/watch/multi-institutional-analysis-of-choledocholithiasis-in-pediatric-vs-adult-patients-10122?t=11)
- "724 patients were included in the study" — Alex Halpern (epidemiological) [Ep 3 · 0:22](https://qa.library.globalcastmd.com/watch/multi-institutional-analysis-of-choledocholithiasis-in-pediatric-vs-adult-patients-10122?t=22)
- "Surgery first approach with upfront laparoscopic cholecystectomy with intraoperative cholangiogram was performed in 201 pediatric patients and 169 adult patients" — Alex Halpern (clinical) [Ep 3 · 0:25](https://qa.library.globalcastmd.com/watch/multi-institutional-analysis-of-choledocholithiasis-in-pediatric-vs-adult-patients-10122?t=25)
- "Laparoscopic common bile duct exploration was attempted in 84 children and 140 adults in the surgery first group" — Alex Halpern (clinical) [Ep 3 · 0:35](https://qa.library.globalcastmd.com/watch/multi-institutional-analysis-of-choledocholithiasis-in-pediatric-vs-adult-patients-10122?t=35)
- "Common bile duct exploration success was higher in pediatric than adult patients" — Alex Halpern (clinical) [Ep 3 · 0:43](https://qa.library.globalcastmd.com/watch/multi-institutional-analysis-of-choledocholithiasis-in-pediatric-vs-adult-patients-10122?t=43)
- "Complication rates were similar between pediatric and adult patients in the surgery first approach" — Alex Halpern (clinical) [Ep 3 · 0:43](https://qa.library.globalcastmd.com/watch/multi-institutional-analysis-of-choledocholithiasis-in-pediatric-vs-adult-patients-10122?t=43)
- "A surgery first approach can be a safe and effective tool for managing choledocholithiasis in pediatric patients" — Alex Halpern (opinion) [Ep 3 · 0:49](https://qa.library.globalcastmd.com/watch/multi-institutional-analysis-of-choledocholithiasis-in-pediatric-vs-adult-patients-10122?t=49)
- "The study was a multi-center retrospective study conducted in the US from 2018 to 2022" — Cecilia Gigena (epidemiological) [Ep 1 · 0:09](https://qa.library.globalcastmd.com/watch/transcystic-laparoscopic-common-bile-duct-exploration-for-pediatric-patients-with-choledocholithiasis-8558?t=9)
- "The study aim was to compare patients with suspected choledocholithiasis who underwent transcystic laparoscopic common bile duct exploration versus those who underwent ERCP first" — Cecilia Gigena (epidemiological) [Ep 1 · 0:09](https://qa.library.globalcastmd.com/watch/transcystic-laparoscopic-common-bile-duct-exploration-for-pediatric-patients-with-choledocholithiasis-8558?t=9)
- "The study included 252 patients total" — Cecilia Gigena (epidemiological) [Ep 1 · 0:28](https://qa.library.globalcastmd.com/watch/transcystic-laparoscopic-common-bile-duct-exploration-for-pediatric-patients-with-choledocholithiasis-8558?t=28)
- "156 patients were in group one (transcystic laparoscopic common bile duct exploration)" — Cecilia Gigena (epidemiological) [Ep 1 · 0:28](https://qa.library.globalcastmd.com/watch/transcystic-laparoscopic-common-bile-duct-exploration-for-pediatric-patients-with-choledocholithiasis-8558?t=28)
- "96 patients were in group two (ERCP first)" — Cecilia Gigena (epidemiological) [Ep 1 · 0:38](https://qa.library.globalcastmd.com/watch/transcystic-laparoscopic-common-bile-duct-exploration-for-pediatric-patients-with-choledocholithiasis-8558?t=38)
- "Patients in group one (transcystic laparoscopic approach) had significantly less complication rates compared to group two" — Cecilia Gigena (clinical) [Ep 1 · 0:38](https://qa.library.globalcastmd.com/watch/transcystic-laparoscopic-common-bile-duct-exploration-for-pediatric-patients-with-choledocholithiasis-8558?t=38)
- "Patients in group one (transcystic laparoscopic approach) had lower length of stay compared to group two" — Cecilia Gigena (clinical) [Ep 1 · 0:38](https://qa.library.globalcastmd.com/watch/transcystic-laparoscopic-common-bile-duct-exploration-for-pediatric-patients-with-choledocholithiasis-8558?t=38)
- "Attempting a transcystic laparoscopic common bile duct exploration may benefit pediatric patients with choledocholithiasis" — Cecilia Gigena (opinion) [Ep 1 · 0:52](https://qa.library.globalcastmd.com/watch/transcystic-laparoscopic-common-bile-duct-exploration-for-pediatric-patients-with-choledocholithiasis-8558?t=52)
- "Choledocholithiasis stones may be made up of bile pigments or calcium and cholesterol salts." — Cecilia Gigena (host_summary) [Ep 2 · 0:43](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=43)
- "Risk factors for choledocholithiasis include metabolic diseases, hemolysis such as sickle cell, and congenital biliary anomalies like choledochal cysts." — David Vitale (clinical) [Ep 2 · 0:55](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=55)
- "Choledocholithiasis is more common in older children, children with higher BMI, and patients of Hispanic ethnicity." — David Vitale (epidemiological) [Ep 2 · 1:03](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=63)
- "According to ASGE guidelines, patients with high probability of common bile duct stones (common bile duct stones seen on ultrasound, ascending cholangitis, or quite high bilirubin) should go straight to ERCP." — David Vitale (host_summary) [Ep 2 · 1:52](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=112)
- "Patients with intermediate risk (abnormal liver biochemical tests or dilated common bile ducts) can undergo endoscopic ultrasound, MRCP, laparoscopic cholangiogram, or intraoperative ultrasound." — Cecilia Gigena (host_summary) [Ep 2 · 2:11](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=131)
- "In pediatric literature, direct (conjugated) bilirubin more than 2 mg/dL was the most predictive factor for common bile duct stones." — David Vitale (host_summary) [Ep 2 · 2:40](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=160)
- "Common bile duct diameter greater than 6 millimeters was most sensitive for predicting common bile duct stones in children, although without statistical significance." — Cecilia Gigena (host_summary) [Ep 2 · 2:50](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=170)
- "The pediatric duct score (published in Journal of American College of Surgeons with 10 centers) identified three most predictive risk factors: ducts greater than 6 mm, common bile duct stones on ultrasound, or total bilirubin greater than 1.8 mg/dL." — David Vitale (host_summary) [Ep 2 · 3:03](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=183)
- "Pediatric literature with small sample size shows that same-anesthesia laparoscopic cholecystectomy with ERCP in stone disease led to less anesthesia time and lower length of stay." — David Vitale (host_summary) [Ep 2 · 3:41](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=221)
- "Retrospective data comparing ERCP versus laparoscopic common bile duct exploration is conflicted and the choice is institution-dependent and provider-dependent based on expertise." — David Vitale (opinion) [Ep 2 · 4:03](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=243)
- "Randomized trials from 2013 show no significant difference in morbidity, mortality, retained stones, or failure rates between ERCP and laparoscopic common bile duct exploration." — Cecilia Gigena (host_summary) [Ep 2 · 4:18](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=258)
- "Stones above the cystic duct pose a problem because they can float up during attempted laparoscopic removal, making a straightforward procedure much more difficult." — David Vitale (clinical) [Ep 2 · 4:39](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=279)
- "Local expertise and availability is the most important factor in the decision tree between ERCP and laparoscopic common bile duct exploration." — David Vitale (opinion) [Ep 2 · 5:00](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=300)
- "Most free-standing children's hospitals do not have ERCP capabilities." — Cecilia Gigena (host_summary) [Ep 2 · 8:59](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=539)
- "Dr. Neff uses a 12-gauge angiocath for access, which may be hard to find in pediatric hospitals but can be ordered." — Luke Neff (clinical) [Ep 2 · 9:37](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=577)
- "The angle of entry into the cystic ductotomy should be as flat as possible, which is why a new incision is made rather than using existing ports." — Luke Neff (clinical) [Ep 2 · 9:42](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=582)
- "Dr. Neff uses a 6 French urethral stent cut down shorter for better flow, with a glide wire inside, using a coaxial technique to navigate the valves of Heister." — Luke Neff (clinical) [Ep 2 · 9:57](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=597)
- "Dr. Neff typically uses either a 6 millimeter or 8 millimeter angioplasty balloon, but definitely not more than that." — Luke Neff (clinical) [Ep 2 · 10:37](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=637)
- "The balloon dilation technique involves inflating the balloon in the duct, pulling back for tactile feedback to locate the sphincter, partially deflating, straddling the ampulla, then going to full profile under fluoroscopy and holding for about 5 minutes." — Luke Neff (clinical) [Ep 2 · 11:02](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=662)
- "Never use a balloon larger than the dilated common bile duct, as adult literature shows higher rates of pancreatitis with ampullary dilation without sphincterotomy." — David Vitale (clinical) [Ep 2 · 11:23](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=683)
- "After balloon dilation, Dr. Neff creates a seal on the distal common duct by partially inflating a balloon straddling the cystic duct-common duct junction so that flushing through the guide wire lumen gets pressurized downstream." — Luke Neff (clinical) [Ep 2 · 11:55](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=715)
- "If laparoscopic common bile duct exploration is not successful, Dr. Neff places an endoloop on the cystic duct and refers to GI for ERCP." — Luke Neff (clinical) [Ep 2 · 12:16](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=736)
- "If the pancreatic duct is visualized during fluoroscopy, the procedure should be stopped due to higher risk for pancreatitis." — Cecilia Gigena (host_summary) [Ep 2 · 12:24](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=744)
- "The prevalence of stone disease is increasing." — Luke Neff (epidemiological) [Ep 2 · 12:34](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=754)
- "The learning curve for laparoscopic common bile duct exploration is around 5 to 10 cases, though this is person-specific." — Luke Neff (clinical) [Ep 2 · 13:38](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=818)
- "The position of the 12-gauge angiocath is critical, and the ability to manipulate the catheter and wire in the duct depends on the initial setup and how flat the angle of entry is into the cystic duct." — Luke Neff (clinical) [Ep 2 · 13:24](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=804)

## Changelog
- Sep 12: 1 item no longer name choledocholithiasis
- Sep 7: 1 item added automatically
- Sep 7: 3 items added automatically

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