Identification of risk factors involved in recurrence after common bile duct stone removal with ERCP

Abstract

Recurrent stone detection is common after endoscopic treatment of common bile duct stones (CBDS). This study aimed to identify the risk factors for recurrence of CBDS.We retrospectively evaluated 14 patients who underwent endoscopic treatment for CBDS. Risk factors for single and multiple recurrent CBDSs were evaluated using logistic regression analysis.Endoscopic and needle-knife precut sphincterotomy was performed in 506 and 112 patients, respectively. There was 1 recurrence in 85 patients (13.8%), 2 recurrences in 23 patients (3.7%), and 3 recurrences in 9 patients (1.5%). According to the multivariate analyses, being older than 65 years (odds ratio [OR] 1.084, P = .000), concomitant heart disease (OR 2.528, P = .002), concomitant lung disease (OR 1.766, P = .035), a large common bile duct diameter (OR 1.347, P = .000), presence of cholelithiasis (OR 1.752, P = .018), stent (OR 1.794, P = .023), or T-tube placement in the common bile duct (OR 47.385, P = .000), and prolongation of the procedure (OR 1.037, P = .000) increased the risk of recurrence, while having undergone cholecystectomy due to gallstones (OR 1.645, P = .042). The mean stone diameter (P = .059), nitroglycerin use (P = .129), and periampullary diverticulum (P = .891) did not increase the risk of recurrent CBDS.The probability of multiple recurrences after the first recurrence of CBDS increased with age >65 years, concomitant heart/lung diseases, stent/T-tube placement in the common bile duct, a wide common bile duct (≥10 mm), and cholelithiasis.Abbreviations: CBDS = common bile duct stones, CI = confidence interval, CNS = central nervous system, EPBD = endoscopic papillary balloon dilatation, EST = endoscopic sphincterotomy, GBS = gall bladder with stones, OR = odds ratio, PAD = periampullary diverticulum.

Recurrence of common bile duct stones after endoscopic clearance and its predictors: A systematic review

“…Overall, 35 studies ( n = 11,771) reported the recurrence of CBD stones after initial clearance with ERCP 1–6,11–27,29–41 . The pooled event rate for the recurrence of CBD stones was 12.6% (95% confidence interval [CI]: 11.2–13.9; I 2 = 79.2%).…”

“…Figure 1 shows the PRISMA diagram for the study selection and inclusion process. A total of 37 studies with 12,952 patients were included in the final analysis 1–6,11–41 . Table 1 shows the baseline characteristics of the studies included in the present meta‐analysis, along with the study quality assessment.…”

“…Adhesion and accumulation of the bile salt inside the stent lead to stent blockage with resultant sludge and stone formation. Also, the CBD's mucosa may become inflamed due to an increased bile concentration, precipitating inflammatory cells and resulting in stone recurrence 36 . Hence, in the absence of gallbladder stones and in patients who have undergone cholecystectomy, the bile duct stent should be removed as early as possible.…”

“…However, the role of cholecystectomy in patients with BDS without gallbladder stones is controversial. Five studies reported that an in‐situ gallbladder with stones increases the risk of CBD stone recurrence, 3,4,12,17,29 while six studies reported that cholecystectomy increases the recurrence risk 3,5,11,13,36,37 . The release of the stored bile by the gallbladder in bulk has a flushing action, which prevents stone formation in the bile duct.…”

“…Assessment of publication bias with funnel plot and (b) Bubble plot for meta-regression for the effect of duration of follow-up on heterogeneity in the recurrence of bile duct stone. studies), 1,14,16,21,22,28,31 cholecystectomy (six studies), 3,5,11,13,36,37 multiple stones in the bile duct (five studies), 22,27,30,31,37 use of mechanical lithotripsy (five studies), 3,11,24,33,41 higher age (four studies), 28,31,36,41 type I periampullary diverticulum (three studies), 6,13,26 in-situ gallbladder with stones (five studies), 3,4,12,17,29 and bile duct stent placement (three studies). 31,33,36…”