Risk factors for recurrence of primary bile duct stones after endoscopic biliary sphincterotomy

doi:10.1067/mge.2001.115335

Gastrointestinal Endoscopy

Volume 54, Issue 1, July 2001, Pages 42-48

https://doi.org/10.1067/mge.2001.115335 Get rights and content

Abstract

Background: Endoscopic biliary sphincterotomy (EST) is a well-established procedure for bile duct stone extraction. Bile duct stones can be classified as primary or secondary. However, few data are available on the recurrence of primary and secondary bile duct stones after EST. Therefore risk factors for the recurrence of primary bile duct stones after EST were prospectively studied. Methods: Between 1991 and 1997, 61 patients underwent EST for primary bile duct stones. All met the following criteria: (1) previous cholecystectomy without bile duct exploration, (2) detection of bile duct stones at least 2 years after initial cholecystectomy. Mean follow-up was 2.2 years. Fourteen patients were lost to follow-up. The recurrence of primary bile duct stones was defined as the detection of bile duct stones no sooner than 6 months after complete clearance of primary bile duct stones. Results: The overall recurrence rate of primary bile duct stones was 21% (10 of 47). Two significant risk factors for recurrence were identified by multivariate analysis: (1) patients with a bile duct diameter of 13 mm or greater after stone removal had recurrences more frequently than those with a duct diameter of 13 mm or less, and (2) patients whose papilla was located on the inner rim or deep within a diverticulum, so that the papillary orifice was not visible endoscopically, had more frequent recurrences than patients with a papilla outside the diverticulum, or no peripapillary diverticulum. Conclusion: The independent risk factors for recurrence of primary bile duct stones were sustained dilation of the bile duct even after complete removal of stones and location of the papilla on the inner rim or deep within a diverticulum. (Gastrointest Endosc 2001;54:42-8.)

Section snippets

Patients and methods

ERCP with EST for bile duct stones was performed in 719 patients between June 1991 and June 1997. The patients were followed prospectively until the time of analysis (December 1998). All patients gave informed consent and the study was approved by the ethical committee of our medical center.

Patients were classified as having primary bile duct stones if they met all of the following criteria as proposed by Saharia et al.¹⁸: (1) previous cholecystectomy without bile duct exploration, (2)

Results

Sixty-one patients were included in the study (Table 1).

. Clinical characteristics of patients and ERCP findings at admission

Empty Cell	Primary bile duct stone (n = 47)
Age	65.3 ± 10.7
Gender (M/F)	25/22
Jaundice (%)	17 (36.2)
Aspartate transaminase (IU/L)	85.6 ± 14.4
Alanine transaminase (IU/L)	104.5 ± 17.1
Alkaline phosphatase (IU/L)	466.1 ± 423.8
Peripapillary diverticulum	15 (32.9)
Type A (%)	7 (14.9)
Type B (%)	8 (17.0)
Stone number
Stone = 1 (%)	27 (57.4)
Stone ≥2 (%)	20 (42.6)
Stone size (mm)	11.4 ± 3.7
Bile duct diameter (mm)

Discussion

ERCP with EST is the therapeutic procedure of choice for bile duct stones. Various complications of EST have been reported: early complications included acute pancreatitis, bleeding, duodenal perforation, acute cholangitis, and acute cholecystitis; late complications included recurrence of stones and papillary stenosis.14, 23, 24, 25 In long-term follow-up studies after EST, the recurrence rate of bile duct stones in patients in whom the gallbladder has been removed has been in the range of 4%

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Long-term prognosis and risk factors associated with post-ERCP pneumobilia in patients with common bile duct stones
2024, Gastrointestinal Endoscopy
Post-ERCP pneumobilia is not uncommon; however, studies focusing on the long-term prognosis of patients with post-ERCP pneumobilia are limited. This study aimed to explore long-term prognosis and risk factors associated with post-ERCP pneumobilia in patients with common bile duct stones (CBDSs).
We conducted a retrospective analysis of 1380 patients who underwent ERCP for CBDSs at our hospital from January 2010 to December 2017. Patients were selected based on inclusion and exclusion criteria and divided into pneumobilia and nonpneumobilia groups, followed by propensity score matching. The matched groups were then compared in terms of incidence rates of both single and multiple recurrences of CBDSs, acute cholangitis, and acute cholecystitis. Multivariate logistic regression analysis was used to explore risk factors associated with pneumobilia.
After propensity matching, there was no significant difference in the rate of single recurrence of CBDSs (22.5% vs 30%; P = .446) between the pneumobilia and nonpneumobilia groups. However, the incidences of multiple recurrences of CBDSs (32.5% vs 12.5%; P = .032) and acute cholangitis without stone recurrence (32.5% vs 2.5%; P = <.001) were significantly higher in the pneumobilia group. Based on multivariate logistic regression analysis, in addition to a dilated CBD (diameter of >1 cm) (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.03-3.76; P = .043), endoscopic sphincterotomy with moderate incision (OR, 5.38; 95% CI, 1.14-25.47; P = .034) and with large incision (OR, 8.7; 95% CI, 1.83-41.46; P = .007) were identified as independent risk factors for pneumobilia after initial ERCP.
Patients with post-ERCP pneumobilia have increased risk of multiple recurrences of CBDSs and acute cholangitis without stone recurrence. Independent risk factors for pneumobilia include peripapillary diverticulum, a dilated CBD (>1 cm), and endoscopic sphincterotomy with moderate and large incisions. A normal-sized CBD appears to serve as a secondary barrier against enterobiliary reflux, necessitating further research for confirmation.
Endoclip papilloplasty for a patulous and incompetent biliary papilla
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La coledocolitiasis puede tratarse mediante abordaje endoscópico por colangiopancreatografía endoscópica retrógrada o realizando una exploración laparoscópica de la vía biliar principal (ELVBP) durante la colecistectomía. La recurrencia de la coledocolitiasis y sus factores de riesgo tras extracción endoscópica han sido ampliamente investigados. Nuestro objetivo es analizar los factores de riesgo asociados con la recurrencia de cálculos en la vía biliar principal después de una ELVBP.
Los pacientes que se sometieron a ELVBP desde febrero de 2004 a julio de 2016 fueron examinados en un análisis univariante y multivariante para estudiar la asociación de recurrencia de coledocolitiasis con las siguientes variables: sexo; edad; presencia de hepatopatía; dislipemia, obesidad, o diabetes mellitus; cirugía abdominal previa; presencia de colecistitis, colangitis o pancreatitis al diagnóstico; pruebas de función hepática preoperatorias, número de cálculos recuperados; método de limpieza y cierre del conducto biliar común; presencia de litiasis coledocianas impactadas o intrahepáticas; conversión a cirugía abierta y morbilidad postoperatoria.
Se incluyeron 156 pacientes. La tasa de recurrencia de la coledocolitiasis fue del 14,1%, con un tiempo medio de recurrencia de 38,18 meses. La edad fue el único factor de riesgo independiente para la recurrencia de cálculos en el análisis univariante y multivariante. Ningún paciente menor de 55 años desarrolló nuevos cálculos en la vía biliar principal, y el 86,4% de las recurrencias se produjo en pacientes mayores de 65 años.
La edad es el único factor de riesgo independiente asociado a la recurrencia de coledocolitiasis después de ELVBP. Diferentes mecanismos en el desarrollo de cálculos en la vía biliar principal pueden estar presentes para pacientes más jóvenes y de edad más avanzada.
Choledocholithiasis may be treated following an endoscopic approach or by laparoscopic common bile duct exploration (LCBDE). Stone recurrence following endoscopic management has been extensively investigated. We analyze the risk factors associated with stone recurrence following LCBDE.
Patients who underwent LCBDE from February 2004 to July 2016 were examined in an univariate and multivariate analysis to assess the association of stone recurrence with the following variables: gender; age; hepatopathy; dyslipidemia, obesity or diabetes mellitus; previous abdominal surgery; presence of cholecystitis, cholangitis or pancreatitis; preoperative liver function tests, number of retrieved stones; method of common bile duct clearance and closure; presence of impacted or intrahepatic stones; conversion to open surgery and postoperative morbidity.
A total of 156 patients were included. Recurrence rate for choledocholithiasis was 14.1% with a mean time to recurrence of 38.18 month. Age was the only independent risk factor for stone recurrence at univariate and multivariate analysis. No patient aged under 55 years developed new common bile duct stones, and 86.4% of the recurrences occurred in patients aged above 65.
Age is the only independent risk factor associated to choledocholithiasis recurrence following LCBDE. Different mechanism in common bile duct stone development may be present for younger and older patients.
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^☆: Reprint requests: Myung-Hwan Kim, MD, Department of Internal Medicine, Asan Medical Center, 388- Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea.

^☆☆: Gastrointest Endosc 2001;54:42-8

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Original ArticleRisk factors for recurrence of primary bile duct stones after endoscopic biliary sphincterotomy☆,☆☆

Abstract

Section snippets

Patients and methods

Results

Discussion

Gastrointest Endosc

Gastroenterology

Gastrointest Endosc

Gastroenterology

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Am J Surg

Am J Surg

Endoskopische sphinkterotomie der papilla veteri und steinextraktion aus ductus choledochus

Dtsch Med Wschr

Endoscopic sphincterotomy for stones by experts is safe, even in younger patients with normal ducts

Ann Surg

Follow-up of more than 10 years after endoscopic sphincterotomy for choledocholithiasis in young patients

Br J Surg

Long-term follow-up after endoscopic sphincterotomy

Endoscopy

Long-term results after endoscopic papillotomy

Endoscopy

Early and late complications after endoscopic sphincterotomy for biliary lithiasis with and without the gall bladder “in situ.”

Gut

Long-term follow-up study of patients after endoscopic sphincterotomy for choledocholithiasis

Scand J Gastroenterol

Long-term follow-up after endoscopic sphincterotomy (EST)

Endoscopy

Endoscopic sphincterotomy: long-term results in 408 patients with complete follow-up

Endoscopy

Late results of endoscopic sphincterotomy for bile duct stones in elderly patients with gall bladders in situ

Gut

Pathophysiology of bile duct stones

World J Surg

Primary common duct stones

Ann Surg

Original Article
Risk factors for recurrence of primary bile duct stones after endoscopic biliary sphincterotomy☆,☆☆