Analysis Of Related Factors For Recurrence Of Common Bile Duct Stones After Endoscopic Retrograde Cholangiopancreatography

Objective To investigate the risk factors for recurrence of common bile duct stones after endoscopic stone extraction by endoscopic retrograde cholangiopancreatography(ERCP).Methods Patients who underwent endoscopic treatment of common bile duct stones between January 2013 and June 2018 in our medical center were retrospectively reviewed.Information including general characteristics,concomitant diseases,previous operation history,juxtapapillary duodenal diverticula,features of biliary tract and stones,ERCP-related factors,laboratory and radiological examinations after ERCP was collected.All patients were followed up until January 2019 and allocated into recurrent group and non-recurrent group.The follow-up result was analyzed.Cox regression analysis was used to identify relevant factors for recurrence of common bile duct stones after ERCP.Factors showing statistically significant differences in the univariate analysis were taken into the multivariate analysis.The cumulative incidence of stone recurrence was calculated by Kaplan-Meier analysis.Results 1.Follow-up result: A total of 869 patients(486 men,383 women)were enrolled.The mean age of the patients was 65.70±13.25 years old.The median follow-up period was 38 months(range 6 to 72 months).The recurrence of common bile duct stones occurred in 92(45 men,47 women)of 869patients(10.59%)and the mean age was 65.90±11.80 years.The mean time of recurrence of common bile duct stones was 65.44 months.There were statistically significant differences in history of choledochotomy,gallbladder status,preoperative cholecystitis and/or cholangitis,diameter of common bile duct,history of ERCP,types of papillotomy between recurrent group and non-recurrent group(P < 0.05),while no statistically significant differences between the two groups were observed in other factors.2.According to the univariate analysis,factors including history of choledochotomy,gallbladder status,preoperative cholecystitis and/or cholangitis,diameter of common bile duct,history of ERCP,types of papillotomy affected common bile duct stone recurrence after stone removal by ERCP(P < 0.05),whereas gender,age,smoking and drinking history,hypertension,diabetes mellitus,hyperlipidemia,history of Billroth ? subtotal gastrectomy,juxtapapillary duodenal diverticula,number of stones,length of the biggeststone,pre-cut papillotomy,balloon dilation,mechanical lithotripsy,serum amylase at 3hours after ERCP and in next morning and pneumobilia on CT scan in next morning were not related to recurrence(P>0.05).3.The variables found to be significant in univariate analysis were included in a multivariate Cox regression analysis.The multivariate Cox regression analysis revealed that diameter of common bile duct > 11mm(hazard ratio[HR]=1.852,95%CI:1.045 ? 3.282,P=0.035),history of ERCP(HR=2.519,95%CI:1.256?5.052,P=0.009),pre-ERCP cholecystectomy(HR=2.949,95%CI:1.616?5.380,P < 0.001)were independent risk factors related to stone recurrence while post-ERCP cholecystectomy(HR=1.711,95%CI:0.822 ? 3.562,P=0.151)was not an independent risk factor.In addition,if patients had intact gallbladder in situ,there were no differences in patients with or without gallbladder stones(P>0.05).4.The cumulative recurrence rates at 1,3,and 5 years were 2.82%,10.23%,and 15.41%,respectively.Conclusions 1.The recurrence rate is 10.59%.The cumulative recurrence rates at 1,3,and 5 years are 2.82%,10.23%,and 15.41%,respectively.2.History of choledochotomy,gallbladder status,preoperative cholecystitis and/or cholangitis,diameter of common bile duct,history of ERCP,types of papillotomy are correlated with common bile duct stone recurrence after ERCP.3.Dilation of common bile duct(diameter >11mm),history of ERCP and pre-ERCP cholecystectomy are independent risk factors for recurrence of stones after endoscopic treatment of common bile duct stones while cholecystectomy after ERCP does not increase the risk.4.The recurrence of common bile duct stones is likely to be affected by multiple factors.Regular follow-ups are necessary for patients with common bile duct dilation and history of ERCP and it is recommended that cholecystectomy is performed after ERCP procedure in patients with gallbladder stones.