| Objective: To systematically evaluate the risk factors for recurrence of choledocholithiasis after endoscopic retrograde cholangiopancreatography(ERCP)by meta-analysis,and to provide evidence for prediction and prevention of recurrence.Methods:China Knowledge Network(CNKI),Cochrane Library,VIP Chinese Journal,Pubmed and Wanfang were searched by computer for articles on recurrence factors of choledocholithiasis after endoscopic retrograde cholangiopancreatography(ERCP).According to the results of the diversity test,a suitable effect model was selected to combine the data and combined 95% CI of each influence Egger’s test was used for publishing bias and used sensory analysis to assess the reliability of the results.Results: This Meta-analysis finally included 18 literatures,with a total of 9231 patients after ERCP,of which 1322 cases recurred.The combined effect size OR and95%CI of angle <145°,previous biliary surgery,stone diameter>1cm,paraduodenal diverticulum,intraoperative biliary lithotripsy,and bile duct stricture were 1.51(1.07,2.12)and 1.68(1.19,2.39),2.74(2.30,3.26),2.95(1.49,5.85),5.36(3.90,7.37),3.87(2.36,6.34),2.77(1.95,3.93),1.78(1.48,2.14),2.87(2.18,3.77),and the difference was statistically significant(P values were 0.02,0.004,<0.00001,0.002,<0.00001,<0.00001,<0.00001,<0.00001,<0.00001),cholecystectomy,choledocholithiasis ≥2Diameter of common bile duct >1.5cm,angulation of common bile duct <145°,previous biliary duct surgery,stone diameter >1cm,paraduodenal diverticulum,intraoperative biliary lithotripsy,bile duct stricture and common bile duct stones after ERCP Recurrence was positively correlated,and the combined OR and 95%CI of female,age ≥65 years,complicated with cholecystolithiasis,and intraoperative endoscopic sphincterotomy(EST)were 1.13(0.99,1.29,respectively),1.03(0.86,1.24),0.79(0.61,1.04),1.15(0.71,1.87),the differences were not statistically significant(P values were 0.06,0.73,0.09,0.57),and the results did not change after sensitivity analysis,it is tentatively believed that women,age ≥ 65 years,complicated with cholecystolithiasis,and intraoperative endoscopic sphincterotomy(EST)of the duodenal papilla are not associated with recurrence of common bile duct stones after ERCP.Conclusion: Meta-analysis results include cholecystectomy,≥ 2 global gallstones,and > 1.5 cents in the possibility of recurrence of common gallstones after the ERCP.Meters,145°< C,previous gastrointestinal surgery,and stone > 1cm,paraduodenal diverticulum,intraoperative biliary lithotripsy,and gastrointestinal tract. |
