Risk Factors For Stone Recurrence After Endoscopic Treatment Of Common Bile Duct Stones

ObjectiveTo investigate the efficacies and long term outcomes of endoscopic papillary large balloon dilation(EPLBD)combine endoscopic sphincterotomy(EST)vs EST for common bile duct(C BD)stones,and the risk factors for stone recurrence of CBD stones after treatment with endoscopic retrograde cholangiopancreatography(ERCP).Methods1.Collected the patients data who underwent ERCP from July 2007 to December 2011 for CBD stones.Stone recurrence were retrospectively investigated.The risk factors involved in recurrence including gender,age,history of cholecystectomy,diameter of CBD,number of stones,gallstones,papillary diverticulum(PAD),mechanic lithotripsy(ML)and endoscopic nasobiliary drainage(ENBD)were assessed by univariate analysis and multivariate logistic regression analysis.2.Patients data who underwent EPLBD combine EST or EST for CBD stones from Jan 2010 to December 2011 were reviewed and followed up.The rates of success,mechanical lithotripsy,complications and stone recurrence were compared between the EPLBD group and the EST group.The rates of success and mechanical lithotripsy were also compared between the subgroup of EPLBD and EST(stone diameter ?12mm).The risk factors involved in recurrence including gender,age,EST,diameter of CBD,papillary diverticulum,mechanic lithotripsy,history of cholecystectomy and gallstones were assessed by univariate analysis and multivariate logistic regression analysis.Results1.A total of 1699 patients were followed up with a mean duration of 55.6 months.Male comprised 49.8% of the population.The mean age of the patients was 61.55±15.341 y.The rate of complication of ERCP was 4.6%.One hundred and thirty four(7.9%)patients developed stone recurrence with a mean duration of 24 months.The mean age of the recurrence group and the without recurrence group were 64.25±14.016 y and 61.32±15.432 y,respectively(p=0.034).The mean C BD diameter of the recurrence group and the without recurrence group were 1.613±0.5386 cm and 1.408±0.5094 cm,respectively(p=0.001).The univariate analysis showed that diameter of C BD?13mm(p=0.001),history of cholecystectomy(p=0.001),number of stones?2(P=0.042),mechanic lithotripsy(p=0.010)were statistically different between the 2 groups.Multivariate analysis showed diameter of CBD?13mm(OR=1.607,95 % CI: 1.051-2.456,p=0.028),history of cholecystectomy(OR=7.101,95%CI:4.539-11.108,p=0.001),gallstones(OR=2.441,95%CI:1.417-4.206,P=0.001)are independent risk factors for stone recurrence.2.A total of 767 patients were followed up with a mean duration of 47.3 months.Male comprised 48.5% of the population.The mean age of the patients was 61.15±15.547 y.Four hundred and seventy patients underwent EST and 297 patients underwent EPLBD.The mean age of the EPLBD group and the EST group were 63.19±15.850 y and 59.86±15.228 y,respectively(p=0.004).The mean CBD diameter of the EPLBD group and the EST group were 1.421±0.6195 cm and 0.861±0.5358 cm,respectively(p=0.001).The complication rate of ERCP was 6.4%(49/767),with mostly were acute pancreatitis(4.8%).Four cases of hemorrhage were all happened in the EPLBD group.The complication rate of ERCP in the EPLBD group and the EST group were 5.7% and 6.8%,respectively(p=0.550).There were no significant difference in the success rates and complication rates between the EPLBD group and the EST group.The EPLBD subgroup had a higher success rate and than the EST subgroup.The EPLBD group had a lower stone recurrence rate than the EST group(4.5% vs 8.5%,p=0.039).The univariate analysis showed that age?60y,ML,EST and CBD diameter?15mm were statistically different between 2 groups.Multivariate analysis showed age ?60y(OR=2.204,95%CI:1.134-4.282,P=0.020)?ML(OR=2.315,95%CI:1.085-4.940,p=0.030),EST(OR=2.865,95 % CI:1.447-5.673,p=0.003),CBD diameter?15mm(OR=2.214,95%CI:1.139-4.304,P=0.019)are independent risk factors for stone recurrence.ConclusionAge ?60y,EST,ML,dilation of common bile duct,history of cholecystectomy and gallstones are independent risk factors for recurrence of CBD stones.EPLBD is the better treatment(compared to EST)for removing large CBD stones because EPLBD facilitate complete clearance of C BD stones and prevent further stone recurrence.