Patient Question: Disease:Widening of the common bile duct, gallbladder stones Description:Hello, I am 40 years old, female, have a history of gallbladder stones for 21 years, at the beginning it was a sediment-like stone, often attacked, then nearly 15 years without severe attacks, ultrasound shows fusion into a stone mass, only occasionally the right side of the discomfort, vague pain. Sometimes the stone would fall into the bile duct and I could feel the soreness and swelling, (ultrasound can also confirm that there are some stones around 0.2) but the stone in the bile duct can be discharged by taking some anti-inflammatory and cholestatic tablets. The ultrasound was repeated every year, and 5 years ago, the bile duct was found to be widened at 1.1. The wall of the gallbladder was slightly rough and the size of the gallbladder was normal. After that, the MRI was reviewed every year and there was no significant change in the results. However, this year, there was a stone slipped into the bile duct, which was expelled. I am hesitant to remove the gallbladder because I have poor digestion and GERD, and I am afraid that it will get worse after removal. In addition, the gallbladder function is fine, so I can’t afford to cut it. Some people say that it will increase the incidence of bowel cancer. Is this the case? What do you suggest in my case. What are the effects of a simple widening of the bile duct? Can I keep it for further observation? Hospital Department: Hepatobiliary Surgery Liu Shengli, Department of Hepatobiliary and Pancreatic Surgery, Zhongda Hospital, Southeastern University, China Reply: Hello! Your case is a bit tangled. At present, the indications for cholecystectomy in China are too broad and excessive, and it removes many gallbladders that are still usable. Your case belongs to the intermediate type, there are indications for surgery but can also be conservative, the key is the degree of impact on the quality of life you can still suffer. If you take conservative treatment, it is recommended to take 300mg/night of ursodeoxycholic acid for a long time to prevent and control the morbidity. Patient Question: I am also a medical student, so I am entangled in many things. I have read many doctors’ opinions, and I think you are still more objective, is there any evidence-based medicine about the high incidence of colon cancer? The doctor I have seen said that it should be removed after 10 years of history or more, otherwise it is prone to cancer, is that right? Also, I have a widened bile duct, do I need to deal with it? The incidence of gallbladder stones is higher in women and the amount of surgical resection is considerably higher than in men. In today’s conditions of excessive gallbladder removal would change the sex ratio of colorectal cancer. However, the reality is that this is not the case and the male:female ratio has not changed. If there is good bile translucency in the gallbladder, it means that the bile is renewing normally and the gallbladder is still functional and can continue to work. In the past, the widening of the common bile duct was considered to be compensatory, but I do not agree with this view. Therefore, it is recommended to take ursodeoxycholic acid for a long time to reduce the bile viscosity. Patient question: I was very touched to read your answer, and I can feel that you are a person who is dedicated to your studies. I am from Beijing, and I have seen many top-notch tertiary hospitals, and almost all of them were sent out with one sentence: “Come to me if you decide to do surgery”, meaning that there is no need to explain anything else to you, and most of them think that wide bile duct is Most of them think that the wide bile duct is a non-functional compensator of the gallbladder or a long-term inflammatory irritation of the draining stones, and that it is too late for surgery. No one has ever been so objective as you, and when I put myself in the shoes of a patient, I feel that the current doctor-patient relationship is not without reason! In your analysis, if I don’t use medication to control my bile ducts, there is a possibility that they will continue to widen, right? If I want to be conservative for the time being, all I need to do is to take oral medication and then review it regularly, when what kind of situation will I have to operate? Thank you! Reply from Liu Shengli, Department of Hepatobiliary and Pancreatic Surgery, Zhongda Hospital, Southeast University: Even so, the bile duct will not be re-dilated without secondary stenosis at the lower end. If there is recurrent epigastric pain due to gallstones, or if there is evidence suggesting gallbladder or bile duct obstruction or bile duct stones, then minimally invasive surgery is an option.