Bile duct stones are gallstones in the bile duct. They can start in the gallbladder and migrate into the bile duct or they can form in the bile duct itself. The stones can become lodged in the bile duct, causing a blockage. At the Bile Duct and Pancreatic Diseases Program, part of the University of Michigan’s Division of Gastroenterology, our multidisciplinary team provides the newest in minimally invasive treatments for bile duct stones. These treatments are not widely available and are performed by experienced gastroenterologists with high volumes in these procedures. Gallstones and bile duct stones (also known as choledocholithiasis) are the same, just located in two different areas of the body. Stones may pass spontaneously out of the bile duct on their own. However, when a stone gets stuck in the bile duct, medical intervention is necessary, otherwise inflammation, bacterial infection, and even severe organ damage can occur.
Symptoms for Bile Duct Stones
Often there are no symptoms for bile duct stones until a stone causes a blockage in the bile duct. Then symptoms can include:
- Severe abdominal pain (can occur irregularly and last for hours at a time)
Diagnosing Stones in the Billiary Duct
To diagnose bile duct stones, we begin by conducting comprehensive exam and collecting a thorough history. Bile duct stones can sometimes be seen on an ultrasound or CT scan, although are most reliably diagnosed by either:
- Magnetic resonance cholangiopancreatography (MRCP): A type of MRI, this advanced imaging technique produces very detailed images of the bile ducts, as well as the liver, gall bladder and pancreas.
- Endoscopic ultrasound: Uses a thin, flexible tube called an endoscope passed through the mouth to examine the digestive tract. The ultrasound component produces sound waves that create detailed images.
Treating Bile Duct Stones
Bile duct stones are typically removed using endoscopic retrograde cholangiopancreatography (ERCP), a minimally invasive procedure that combines x-ray and upper endoscopy—an exam of the upper gastrointestinal tract, consisting of the esophagus, stomach and duodenum (the first part of the small intestine)—using an endoscope, which is a lighted, flexible tube, about the thickness of a finger. The doctor passes the tube through the mouth and into the duodenum, then injects a contrast dye into the bile ducts, which can then be seen on x-ray. Special tools can be guided through the endoscope to remove the stones. Large or difficult-to-remove bile duct stones require special ERCP treatments that are not widely available at hospitals throughout the country. They include: Mechanical lithotripsy: This procedure involves breaking up a larger bile duct stone by capturing it and then crushing it in a wire “basket” that is inserted through the endoscope. Once the stones are crushed, they are removed using special tools through the endoscope. Intraductal electrohydraulic lithotripsy: For this procedure, we use a very fine probe inserted through a tiny scope that is passed through the ERCP endoscope. The probe, which is connected to a generator, provides a shock wave that breaks up the stone. Once the stones are crushed, they are removed using special tools through the endoscope. Patients can typically go home same day, once their sedation wears off.
Other Information About Digestive and Liver Health
To see related medical services we offer, visit our Digestive and Liver Health overview page.