Publication Name	World Journal of Gastrointestinal Surgery
Manuscript ID	106712
Country	China

Category	Gastroenterology & Hepatology
Manuscript Type	Retrospective Study
Article Title	Ice-breaking sign: A radiological sign influencing the treatment strategies for choledocholithiasis
Manuscript Source	Unsolicited Manuscript
All Author List	Xiao-Yu Zhao, Ming Chen, Gang Wang, Long Cui, Zhi Xu, Chun-Sheng Hou, Li-Xin Wang, Ling-Fu Zhang and Xiao-Feng Ling
Funding Agency and Grant Number	Funding Agency Grant Number Clinical Cohort Construction Program of Peking University Third Hospital No. BYSYDL2023005 Peking University Third Hospital Innovation Transformation Fund No. BYSYZHZB2023105
Corresponding Author	Xiao-Feng Ling, MD, PhD, Professor, Department of General Surgery, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing 100191, China. xiaofengling@bjmu.edu.cn
Key Words	Choledocholithiasis; Surgical approach; Difficult common bile duct stones; Endoscopic management; Laparoscopic management
Core Tip	This study identified the ice-breaking sign, a novel radiological marker on magnetic resonance cholangiopancreatography, characterized by abrupt distal common bile duct narrowing with proximal dilation in choledocholithiasis. Patients with this sign exhibited markedly lower success rates for endoscopic retrograde cholangiopancreatography (25.0% vs 81.8%) and laparoscopic common bile duct exploration (69.4% vs 93.8%), necessitating advanced techniques like lithotripsy. The sign indicates higher surgical complexity and underscores laparoscopic common bile duct exploration as the preferred approach over endoscopic retrograde cholangiopancreatography. Preoperative recognition aids in risk stratification, optimizing treatment strategies for challenging bile duct stones.
Citation	Zhao XY, Chen M, Wang G, Cui L, Xu Z, Hou CS, Wang LX, Zhang LF, Ling XF. Ice-breaking sign: A radiological sign influencing the treatment strategies for choledocholithiasis. World J Gastrointest Surg 2025; In press

Received	2025-03-06 10:15
Peer-Review Started	2025-03-06 10:15
To Make the First Decision
Return for Revision	2025-04-08 16:51
Revised	2025-04-17 10:15
Second Decision	2025-05-20 02:45
Accepted by Journal Editor-in-Chief
Accepted by Executive Editor-in-Chief	2025-05-20 06:03
Articles in Press	2025-05-20 06:03
Publication Fee Transferred	2025-04-18 07:31
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	1948-9366 (online)
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