The Risk Factors For Recurrence Of Choledocholithiasis After Endoscopic Retrograde Cholangiopancreatography

Background:Choledocholithiasis(common bile duct stones,CBDS)refers to the stones that are located in the common bile duct,which are divided into primary choledocholithiasis and secondary choledocholithiasis.The majority of primary choledocholithiasis are mixed stones of bile pigment,as well as some of their stone cores contain ascarid remnants.Meanwhile,secondary choledocholi-thiasis refers to the stones that are discharged from the gallbladder into the common bile duct principally.The clinical manifestations of choledocholithiasis,including typical symptoms such as recurrent abdominal pain,chills,high fever and jaundice,usually are complex and varied.Those symptoms can recur again and again until the stones are effectively removed through all kinds of therap-ies.In the present,there are numerous treatments for common bile duct stones,including endoscopic treatment,laparoscopic treatment,choledochoscopic treatm-ent,open surgery and so on.However,with the rapid and continuous developme-nt of endoscopic technology,minimally invasive therapy has become the first choice in all treatments.Nowadays,endoscopic retrograde cholangiopancreatograp-hy(ERCP)has been widely used in the treatment of choledocholithiasis.The advantages of endoscopic therapy towards choledocholithiasis are consisted of shorter operative time,quicker recovery time and less damage to body.However,common bile duct stones could recur more than once after successful ERCP treatment in a number of patients.At the same time,this phenomenon has draw-ed more and more attention of clinical doctors and scholars in the world.Purpose:The ultimate purpose of our study is to investigate and discuss the related risk factors of recurrent choledocholithiasis after endoscopic therapy through detailed analysis of the clinical data of patients with choledocholithiasis treated by endoscopic retrograde cholangiopancreatography(ERCP).We hope our research conclusion could provide useful guidance for endoscopic treatment of choledocholithiasis in clinical application in the future.Method:In our research,we analyzed in detail the relevant clinical data of pati-ents who ever hospitalized for choledocholithiasis in the department of gastroe-nterology,central hospital of shandong provincial hospital from January 2014 to December 2017.According to our inclusion criteria and exclusion criteria,we screened out 209 appropriate cases for our research,including 52 cases with the occurance of recurrent choledocholithiasis after the endoscopic therapy and the other 157 cases who didn’t suffer recurrent choledocholithiasis after the same treatment.General information,biliary tract conditions,detail of previous ERCP operation and other relevant data were collected selectively,based on the combination with relevant research and clinical experience.First of all,we sele-cted appropriate statistical methods and conducted single-factor analysis of rele-vant factors in the face of this data.Then multivariate analysis was performed on the significant factors above to screen out the high-risk factors.Result:Among the 209 patients,52 of them appeared with recurrent choledoch-olithiasis.The recurrence rate was 24.88%,and the follow-up time was 12 to 60 months.In single-factor analysis,we found that there were statistically signifi-cant differences in preoperative cholecystectomy,endoscopic mechanical lithotri-psy(EML),number of stones(≥2),number of choledochal diameter(≥15mm),juxtapapillary duodenal diverticula(JPDD),intrahepatic bile duct stones,and postoperative endoscopic nasobiliary drainage(ENBD)between experimental group and control group.Logistic multivariate regression analysis showed that juxtapapillary duodenal diverticula(OR= 2.271,95%ci:1.043-4.947,P= 0.039),intrahepatic bile duct stones(OR=5.334,95%ci:1.922-14.801,P=0.001)and with out postoperative endoscopic nasobiliary drainage or stent placement(OR=6.241,95%ci:1.651-23.598,P= 0.007)were three independent risk factors for recur-re nt choledocholithiasis after endoscopic retrograde cholangiopancreatography.Conclusion:Juxtapapillary duodenal diverticula,intrahepatic bile duct stones and postoperative non-endoscopic nasobiliary drainage/stent placement were three independent risk factors for recurrent choledocholithiasis after endoscopic retr-ograde cholangiopa-ncreatography.At the same time,endoscopic mechanical lith-otripsy,history of cholecystectomy,number of stones(≥2)and number of chole-dochal diameter(≥15mm)were related to the recurrence of common bile duct stones after ERCP operation closely.These factors need to be of great concern to clinicians when performing ERCP operation to cure choledocholithiasis,in order to reduce the probability of recurrence of bile duct stones.