Establishment Of A Prediction Model For The Recurrence Of Common Bile Duct Stones After ERCP

Objective: To investigate the factors influencing the recurrence of choledocholithiasis after ERCP,and the predictive model of recurrence of common bile duct stones after ERCP was established.Methods: By retrospectively collecting the relevant date of 1982 patients with choledocholithiasis who underwent ERCP treatment at the First Hospital of Lanzhou University from Jan.2015 to Dec.2017,104 patients in the recurrence group and 402 patients in the non-recurrence groups were finally included according to the inclusion and exclusion criteria.Cox univariate and multivariate regression analysis were performed on the variables related to the recurrence of choledocholithiasis after ERCP.The predictive model of recurrence of common bile duct stones after ERCP was established according to the regression coefficients.The effect was evaluated by ROC curve and a risk score chart was drawn.Results: Univariate analysis showed that age,the first course of the disease,common bile duct diameter,distal bile duct stricture,number of calculi,maximum calculi diameter,gallbladder status,hyperlipidemia,history of biliary tract surgery,and postoperative biliary drainage mode are significantly different between the recurrent group and the non-recurrent group,Academic differences(HR=1.67,2.18,1.66,2.50,1.51,1.97,1.80,1.77,0.48,1.72,2.63,0.93,3.65,95%CI: 1.11～2.46,1.14 ～4.18,1.03～2.66,1.50～4.15,1.03～2.22,1.12～3.46,0.92～3.50,0.95～3.31,0.19～1.23,1.12～2.64,1.65～4.22,0.39～2.20,1.58～8.46,P<0.05).Cox multivariate analysis showed that the time to the first course of disease,stenosis of the distal common bile duct,hyperlipidemia,history of biliary surgery and stent drainage after ERCP are independent risk factors for recurrence of choledocholithiasis after ERCP(HR=2.33,2.09,1.68,2.57,3.71,95%CI: 1.09～5.00,1.19～3.67,1.06～2.65,1.46～4.52,1.30～10.64,P<0.05).The prediction model was established to the above multi-factor analysis results,the ROC performance evaluation shows that the area under the ROC curve was0.757(95%CI: 0.703-0.811),and the optimal cut-off value was1.41.The sensitivity,specificity and were 69.2% and 72.9% respectively.Conclusion: The first course of the disease,distal bile duct stenosis,hyperlipidemia,history of biliary operation and postoperative biliary drainage are the main risk factor for predicting recurrence of common bile duct stones after ERCP.The established Cox regression model can predict high-risk patients with recurrence of common bile duct stones after ERCP.