A Study On Risk Factors Of Recurrence Of Choledocholithiasis After ERCP

Objective: ERCP(endoscopic retrograde cholangiopancreatography)has become the first choice for the diagnosis and treatment of choledocholithiasis.In clinic,a part of patients had recurrent stones after ERCP,and ERCP was performed many times.At present,the risk factors of recurrent choledocholithiasis are not clear,so this study mainly analyzes the risk factors of recurrent choledocholithiasis after ERCP.Methods: From January 2014 to December 2017,1283 cases of "choledocholithiasis" were admitted to the General Hospital of Ningxia Medical University and "ERCP" was used for stone removal.By December 2019,208 cases of "choledocholithiasis" were admitted to our hospital again.All cases were screened strictly according to the inclusion exclusion criteria,of which 73 cases met the inclusion criteria and were set as the observation group;among the above cases,902 cases were set as the control group without the treatment record of "choledocholithiasis" in our hospital after ERCP.According to the general condition of patients,imaging examination,laboratory examination and operation records,age,gender,cholesterol level,bilirubin level,number of choledocholithiasis,history of cholecystectomy,history of choledochotomy,infection of biliary tract,EST alone were observed,Endoscopic sphincterotomy or EST combined with endoscopic sphincterotomy(EPBD),There are 16 indexes in total,such as whether to have endoscopic lithotripsy,whether to have biliary pancreatitis,whether to have parapapillary diverticulum,whether to have biliary stricture,whether to have biliary stent,whether to have pancreatic duct stent,and the results of bile culture,in order to obtain the risk factors of statistical significance.Results: Statistically significant factors were found to be paratapillary diverticulum and EST+ EPBD,endoscopic lithotripsy,pancreatic stent,history of cholecystectomy,history of exploration of common bile duct,ERCP and logistic regression analysis showed that the significant factors were parapapillary diverticulum(or: 2.441,95% CI: 1.405-4.239),EST + EPBD(or: 0.293,95% CI: 0.165-0.518),endoscopic lithotripsy(or: 4.568,95% CI: 2.387-8.744),history of cholecystectomy(or: 4.121,95% CI: 1)628-10.434),?2 formed stones were analyzed as independent risk factors by single factor X2(x2 value: 18.632,P value: 0.000)Conclusion: The independent risk factors for recurrence of choledocholithiasis after ERCP were associated with paratapillary diverticulum,endoscopic lithotripsy,history of cholecystectomy and more than 2 stones formed during operation,while EST combined with EPBD during operation were the possible factors to reduce recurrence of stones.