Bile duct stones Home A-Z Health Information Health Library A-Z Bile Duct Stones Overview Bile duct stones (also called choledocholithiasis) are solid particles that form in the biliary ducts. These stones can interfere with bile flow, which results in various complications and symptoms. If left untreated, they may cause pain, jaundice, or inflammation of the entire biliary system (cholangitis). Types Based on the origin of bile stones, they can be classified into two categories.Primary bile duct stones: These originate in the bile ducts. They are less common and usually occur in people with conditions that affect bile flow or the chemical composition of bile (e.g., chronic biliary infections or strictures).Secondary bile duct stones: These typically originate in the gallbladder and then relocate to the bile ducts. The stones are usually cholesterol-based. Generally, secondary bile duct stones are more common than primary bile duct stones and are cholesterol-based. Causes Bile ducts can be attributed to multiple factors, including:Abnormal bile composition: If bile has too much cholesterol or too little bile salts, it can lead to stone formation. Conditions like gallbladder disease, biliary cirrhosis, or chronic liver disease can affect bile composition.Bile duct stricture or narrowing: A bile duct stricture or narrowing, often caused by inflammation, infection, or scarring (from previous surgeries, injury, or certain diseases), can make it easier for stones to form and become trapped in the bile duct.Chronic biliary infections: Long-term infections of the bile ducts (e.g., ascending cholangitis) can increase the risk of stone formation due to changes in bile composition.Other medical conditions: Diseases like cirrhosis and pancreatitis, and haematological disorders like sickle cell disease or thalassemia can also predispose individuals to the formation of bile duct stones.Age and gender: Individuals over 40, especially women are at high risk of developing gallstones, and by extension, bile duct stones. Symptoms When a bile duct stone blocks the bile duct, it can cause a range of symptoms, particularly if the stone causes a biliary obstruction or leads to complications like cholangitis or pancreatitis. Common symptoms include:Jaundice: This occurs due to obstruction of bile flow, resulting in bilirubin accumulation in blood, which in normal cases is excreted in bile.Dark urine: This occurs due to excess bilirubin in the bloodstream.Pain: When a stone obstructs bile flow, an intense pain in the right upper abdominal region referred to as biliary colic can occur.Fever and chills: These are signs of cholangitis (bile duct infection), which is a potentially serious complication of bile duct stones.Nausea and vomiting: These symptoms may accompany biliary colic or other complications, particularly in case of bile duct infection or inflammation.Clay-coloured stools: This happens when bile (which gives stool its characteristic brown colour) cannot reach the intestine due to the blockage. Diagnosis To diagnose bile duct stones, doctors may use a combination of the following methods:Ultrasound: Often it is the first imaging test performed. An abdominal ultrasound can detect gallstones, and in many cases, bile duct stones.Endoscopic retrograde cholangiopancreatography (ERCP): The ERCP procedure involves using endoscopy in conjunction with X-ray scanning to examine the bile ducts and pancreas. ERCP is both diagnostic and therapeutic, as it can be used to remove or retrieve stones from the bile ducts.Magnetic resonance cholangiopancreatography (MRCP): This non-invasive MRI-based technique can identify stones or blockages in the bile ducts.CT scan: This can also help identify bile duct stones, especially if there is suspicion of complications such as pancreatitis.Blood tests: These can help identify liver dysfunction, infection, or bile stone-induced obstruction based on elevated levels of liver enzymes (e.g., ALT, AST) and bilirubin, and increased white blood cell counts. Treatment Common treatment options for bile duct stones include:Endoscopic removal (ERCP): This is the most common treatment for bile duct stones, especially if there is a blockage or infection. ERCP can be used to extract stones from the bile duct using specialised tools passed through a flexible tube inserted into the duodenum.Surgery: This modality might be used to extract bile duct stones or treat complications like bile duct strictures. Cholecystectomy (removal of the gallbladder) may also be performed to prevent further stone formation in the future, as it is often the source of the stones.Medications: Although not as common, medications like ursodeoxycholic acid may be used in some cases to dissolve cholesterol stones. This is typically more effective for gallstones than for bile duct stones.Percutaneous transhepatic cholangiography (PTC): If ERCP is not successful or available, this procedure can be used to access the bile ducts through the skin and remove stones. Prevention While it is not always possible to prevent bile duct stones, certain lifestyle modifications can reduce bile duct stone risk:Maintaining a healthy weight: This is important as obesity is associated with enhanced formation of gallstones, which relocate to the biliary system as bile duct stones.Eating a balanced diet: A low-fat and high-fibre diet can help reduce gallstone risk.Managing underlying conditions: Managing pre-existing health issues, like diabetes, high cholesterol, or liver disease, can help lower the risk of bile duct stones.Avoiding rapid weight loss: This is associated with increased risk of gallstone formation, hence when going for weight loss, one should aim for gradual, steady weight loss.