Risk Factors For Long-term Biliary Complications After Endoscopic Papillary Balloon Dilatation

Objective:To investigate the risk factors of long-term complications of Endoscopic Papillary Balloon Dilatation(EPBD)for choledocholithiasis.Methods:The data of patients with choledocholithiasis treated by EPBD from2014-1 to 2018-6 in the second hospital of Hebei Medical University were retrospectively collected.All patients were divided into two groups according to whether long-term complications(including recurrence of CBDs,acute cholecystitis,non calculous cholangitis,liver abscess and death caused by primary diseases of biliary tract)occurred,Kaplan Meier log rank test was used for univariate analysis of the observed factors between the two groups.Cox proportional hazards model was used for multivariate analysis of the significant factors in univariate test.Results:A total of 609 patients,324 males and 285 females,aged between 4 and92 years,were included in the study,the cumulative incidence of long-term complications was 16.7%(102/609),the follow-up time ranged from 29 to 82 months,the average follow-up time was 54.44±14.52 months.Single factor analysis of all the observed factors showed that history of choledocholithiasis(CBDs)stone extraction(χ2=52.839,P<0.001),hepatolithiasis(χ2=39.318,P<0.001),balloon diameter(χ2 = 22.378,P<0.001),stone size(χ2=11.233,P=0.001),number of stones(χ2=26.568,P < 0.001),choledochectasis(χ2=16.836,P<0.001),mechanical lithotripsy(χ2=8.174,P=0.004),low-fat diet(χ2=5.242,P=0.022)had statistical significance.The time of balloon dilatation was not statistically significant in univariate analysis.According to the above significant factors,Cox proportional hazards model showed that exist history of CBDs stone extraction(OR=3.332,95%CI 2.071-5.361,P<0.001),hepatolithiasis(OR = 2.848,95%CI 1.653-4.908,P<0.001),number of stones≧3(OR=2.162,95%CI 1.406-3.323,P<0.001)was the risk factors for long-term complications after EPBD.Conclusions:The long-term effect of EPBD is safely and reliable.The difference of balloon diameter and expansion time did not significantly affect the long-term complications after EPBD.Patients with a history of CBDS stone removal and a large number of common bile duct stones should be followed up regularly to monitor the long-term complications after EPBD.Patients with choledocholithiasis accompanied by intrahepatic bile duct stones should undergo surgical treatment if conditions permit.