| ObjectiveThe aim of the study was to investigate the timing of recurrence, relapse frequency, relapse rate after endoscopic sphincterotomy(EST), and to analyze the high risk factors which precipitate the recurrence of common bile duct stones, to evaluate the efficacy and safety of endoscopic treatment of recurrent common bile duct stones.MethodsA total of 1971 consecutive patients who underwent EST for bile duct stones from June 2000 to September 2002 were prospectively followed up to observe the rate of bile duct stone recurrence after endoscopic sphincterotomy and detect predictors for recurrent bile duct stones. Single factor analysis was performed on the related risk factors.The statistic significant difference was re-introduced by non-condifional logistic regression model for multivariate analysis. The patients with common bile duct stone recurrence were divided into endoscopic treatment group and open surgery group, and were compared of postoperative recovery and complications to evaluate the feasibility, effectiveness and superiority of endoscopic treatment.ResultReliable follow up information was obtained for 1616 of 1971 patients,181 patients (77 men and 104 women; median age 58.3 years.27-81 years)were included in the analyses.32 patients had 2 or more sessions fo recurrence (17 patients had 2 and 15 patients had more relapse). Recurrence interval was from 1.08 to 9.8 years (first relapse).The average recurrence time was 3.8 years.3-year recurrence rate was 3.74%(87 cases),5-year recurrence rate was 7.55%(122 cases),8-year recurrence rate was 11.2%(181 cases).By univariate and multivariate statistical analysis,The "acalculous GB","Cholecystectomy immediately" group was less prone to develop stone recurrence than the "prior cholecystectomy" group and the "calculous GB" group. The need for lithotripsy, the presence/absence of pneumobilia, biliary pneumatosis,is associated with significant increasing of in recurrence rate. The age, sex, number of common bile duct stones, bile duct diameter is not a risk factor for recurrence of common bile duct stones. Normal gallbladder is a protective factor.133 cases of endoscopic treatment group,127 cases were successful treated by endoscopic stone extraction,2 underwent laparoscopy and endoscopy combination therapy,2 cases of biliary plastic stent implantation,1 cases undertook exploratory laparotomy bile duct, biliary-enteric anastomosis. The remaining of 48 cases undertook routine laparotomy(common bile duct exploration and T tube drainage in 39 cases, Choledochoduodenostomy in 9 cases, choledochojejunostomy in 4 cases). Compared to laparotomy group, the endoscopic treatment group have more benefits than routine surgery in hospitalization time, rapid recovery of gastrointestinal function, less postoperative complications.ConclusionThis data shows that common bile duct stone recurrence after EST, the average time was 3.8 years, the recurrence rate was 11.2%. Gallbladder status, ampullary diverticulum, lithotripsy, biliary pneumatosis was an independent risk factor. LC should be carry out in patients with gallstone after EST, Normal gallbladder is a protective factor. Therefore, we do not recommend removal of the gallbladder without gallstones. The previous cholecystectomy, ampullary diverticula, biliary pneumatosis, lithotripsy patients should be alert to the recurrence of common bile duct stones. It is very important to follow up these people closely.Endoscopic therapy should be used as first choice for recurrent bile duct stones after EST. Endoscopic therapy can avoid the trauma of re-operation and patients recover quickly with few complications, The elder, patients with surgical contraindications had more advantages. However,We should be not increase the risk but to pursue the success rate of endoscopic stone extraction in those people who have poor condition of the duodenal papilla, large size or very hard stone, if necessary, laparoscopy and endoscopy combination therapy or plastic endoscopic stent implantation should be considered. |
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