Multiple recurrences after endoscopic removal of common bile duct stones: A retrospective analysis of 976 cases

Abstract

Background and Aim Recurrences after endoscopic treatment of common bile duct stones (CBDS) are common. The aims of this study were to identify risk factors for recurrences of CBDS and to evaluate the effect of interventions for prevention of further recurrences. Methods A total of 976 patients who underwent endoscopic treatment of CBDS were retrospectively studied. Risk factors for single and multiple recurrent CBDS were evaluated using a Cox hazard regression model. The incidences of further recurrences were evaluated according to the additional interventions. Results The mean age was 69.3 years, and 39.3% were female. Endoscopic papillary balloon dilation, endoscopic sphincterotomy, and endoscopic papillary large balloon dilation were performed in 858, 77, and 41 patients, respectively. The rates of one or more recurrence and multiple recurrences of CBDS were 12.4% and 2.7%, respectively. In the multivariate analyses, the significant risk factors were the bile duct size (hazard ratio [HR] 1.07, P = 0.012), gallbladder left in situ with stones (HR 1.91, P = 0.046), and pneumobilia after treatment (HR 2.10, P = 0.047) for single recurrence and the number of stones at the first recurrence (HR 1.16, P = 0.021) for multiple recurrences. In five out of nine cases with multiple recurrences, further recurrence was not observed after additional sphincteroplasty in addition to cholecystectomy. Conclusions The incidence of multiple recurrences was not uncommon after the first recurrence of CBDS.

Alterations of the Bile Microbiome in Recurrent Common Bile Duct Stone

“…The formation of CBDS is the result of a combination of environmental and genetic factors, and the main component is calcium bilirubin. At present, endoscopic retrograde cholangiopancreatography (ERCP) is an important way to treat CBDS [ 2 ], but there are often problems with postoperative recurrence [ 3 ], and the incidence of multiple recurrences was not uncommon after the first recurrence of CBDS [ 4 ].…”

Remaining issues of recommended management in current guidelines for asymptomatic common bile duct stones

“…Multiple recurrence after first recurrence was observed in 26 patients (21.5%) of 121 patients with stone recurrence during a median follow-up period of 5.1 years. The risk factors for single recurrence were CBD size, gallbladder left in situ with gallstones, and pneumobilia after ERCP, and the risk factor for multiple recurrence was the number of CBDS at the first recurrence[ 20 ].…”

“…Based on the previous reports, the risk of early ERCP-related complications, including PEP, cholangitis, bleeding, and perforation can be estimated to approximately 15%-25% with the incidence of PEP of 12%-20% in patients with asymptomatic CBDS[ 9 - 14 ]. The risk of late ERCP-related complications including stone recurrence and cholangitis can be estimated to approximately 10%[ 18 - 20 ], with the risk of early and late ERCP-related complications for asymptomatic CBDS being approximately 25%-35%. The risk of biliary complications in wait-and-see approach during median follow-up period of 30 d to 4.9 years was estimated to be approximately 0%-25%[ 14 - 18 ]; ERCP for asymptomatic CBDS may therefore have poorer outcomes than that of wait-and-see approach.…”

“…Previous studies on the natural history of CBDS reported the biliary complication rates of wait-and-see approach for asymptomatic CBDS to vary between 0-25.3% during a follow-up period of 30 d to 4.8 years[ 14 - 18 ]. Endoscopic sphincterotomy, endoscopic papillary balloon dilation, or endoscopic large papillary balloon dilation was performed for endoscopic stone removal bearing in mind the risk of stone recurrence as these procedures can cause papillary dysfunction[ 19 , 20 ].…”

Puncture and discission with a needle: A new method for laparoscopic common bile duct exploration

“…[ 1 – 4 ] In the past, the most popular management technique for cholecystolithiasis concomitant with choledocholithiasis was endoscopic retrograde cholangiopacreatography (ERCP) with sphincterotomy and stone extraction, followed by laparoscopic cholecystectomy. [ 5 , 6 ] With recent advances in laparoscopic techniques, laparoscopic common bile duct exploration (LCBDE) has become more popular because it is a single-stage procedure with technical success, no damage to the sphincter of Oddi, and shorter hospital stays. [ 2 , 6 , 7 ] However, the identification and discission of the CBD are critically important approaches in LCBDE with well-reported difficulties.…”