Risk Factors For Recurrence Of Common Bile Duct Stones After Endoscopic Retrograde Cholangiopancreatography

BackgroundCholelithiasis is one of the common and frequently occurring diseases of the biliary system,in which stones are produced and exist in the gallbladder or bile vessel.The incidence of gallstones is5%-15%,of which common bile duct stones accounted for 5%-30%.Choledocholithiasis is a kind of gallstones,in which stones originates from the common bile duct or secondary to gallbladder.The clinical manifestations of choledocholithiasis are complex.When combined with acute cholangitis,it will appear abdominal pain,jaundice and high fever(Charcot triad)and with the disease’s progressing,it will appear shock and neuropsychiatric symptoms(Reynolds pentalogy).Especially in elderly patients,there are many postoperative complications.So the treatment of common bile duct stones is very important which includes drug treatment,surgical treatment and endoscopic treatment nowadays.Laparotomy is not the first choice for the treatment of choledocholithiasis because of its disadvantages such as larger trauma,many complications and poor prognosis.In the 1960 s,endoscopic retrograde cholangiopancreatography(ERCP)was used to diagnose the diseases of biliary passage and pancreas.With the development of choledocholithotomy,many techniques such as endoscopic sphincterotomy(EST),endoscopic papillary balloon dilation(EPBD),endoscopic papillary large balloon dilation(EPLBD)have been put into use.ERCP has become the first choice of the diagnosis and treatment of biliary and pancreatic diseases due to its less pain,less expense.However,postoperative complications such as bleeding,perforation,and postoperative acute pancreatitis can not be completely avoided.Studies have shown that the recurrence rate of common bile duct stones is 4%-24%.The recurrence of stones can reduce life quality and increase the economic burden of the patients,so it is very important about how to prevent and reduce the recurrence of stones.Objective:To investigate the risk factors of recurrence of common bile duct stones after endoscopic stone extraction by endoscopic retrograde cholangiopancreatography(ERCP).Materials and methods:Patients who underwent endoscopic treatment of common bile duct stones from January 2018 to January 2020 in Huaihe Hospital of Henan University were retrospectively reviewed.Information including general characteristics,concomitant diseases,laboratory indexes,biliary related data.All patients were followed for two years and allocated into recurrent group and non-recurrent group.We used logistic multivariate analysis to identify the independent risk factors for recurrence of common bile duct stones after ERCP.Result:1.A total of 409 patients were included(201men,208women),the recurrence of common bile duct stones occurred in 60 and the recurrence rate was 14.67%.2.Compare the general characteristics and complicated diseases of recurrent group and non-recurrent group.There were significant differences in sex,age,diabetes mellitus,liver disease,and history of cholecystectomy(P<0.05),whereas BMI,smoking,drinking,and history of hypertension were no significant difference(P>0.05).3.Compare the laboratory indexes of recurrent group and non-recurrent group.There were significant differences in bilirubin direct,alkaline phosphatase,γglutamyl transpeptidase(P<0.05),whereas cholesterol,albumin,creatinine were no significant difference(P>0.05).4.Compare the biliary related data of recurrent group and non-recurrent group.There were significant differences in juxtapapillary duodenal diverticula,common bile duct diameter ≧ 15 mm,EST+EPBD/EST,common bile duct angulation,biliary tract infection,biliary stricture,biliary stent(P<0.05),whereas number of stones,length of the biggest stone,mechanical lithotripsy were no significant difference(P>0.05).5.The area under the curve for common bile duct angulation was 0.812,when the best cut-off value was 45 degree,the sensitivity was 0.75,the specificity was 0.883,the 95% confidence interval was0.748-0.876.The area under the curve for common bile duct diameter was 0.82,when the best cut-off value was 15 mm,the sensitivity was 0.733,the specificity was 0.745,the 95% confidence interval was0.751-0.89.The common bile duct diameter and common bile duct angulation have the predictive value to the recurrence of common bile duct stones.6.The variables found to be significant in univariate analysis were included in logistic m ultivariate regression analysis.The logistic multivariate regression analysis revealed that sex(OR=0.391,95%CI:0.154-0.994,P=0.048),diabetes mellitus(OR=11.855,95%CI:1.689-83.197,P=0.013),history of cholecystectomy(OR=2.979,95%CI:1.023-8.673,P=0.045),common bile duct diameter≧15mm(OR=12.651,95%CI:4.679-34.208,P=0.000),common bile duct angulation<45degree(OR=62.295,95%CI:21.034-184.496,P=0.000),EST+EPBD/EST(OR=6.158,95%CI:2.119-17.894,P=0.000),biliary stricture(OR=3.185,95%CI:1.218-8.327,P=0.018),biliary tract infection(OR=3.144,95%CI:1.071-9.225,P=0.037)were independe nt risk factors for recurrent chaledocholithiasis after endoscopic retrograde cholangiopancreatography.Conclusion:1.Age,liver disease,bilirubin direct,alkaline phosphatase,γglutamyl transpeptidase,juxtapapillary duodenal diverticula,biliary stent were correlated with common bile duct stone recurrence after endoscopic retrograde cholangiopancreatography.2.Sex,diabetes mellitus,history of cholecystectomy,common bile duct diameter≧15mm,com mon bile duct angulation<45degree,EST+EPBD/EST,biliary stricture,biliary tract infection were ind ependent risk factors for recurrent chaledocholithiasis after endoscopic retrograde cholangiopancreato graphy.3.The recurrence of common bile duct stones was affected by many factors,regular follow-ups are necessary for patients who underwent endoscopic treatment of common bile duct stones.