Bile acid profiles in choledocholithiasis and their ability to predict common bile duct stone recurrence after endoscopic retrograde cholangiopancreatography treatment

Abstract

Background/Purpose This study aimed to explore the alteration of bile acid (BA) profiles in patients with choledocholithiasis (CDC) and construct a prediction model for evaluating the risk of common bile duct stone (CBDS) recurrence after endoscopic treatment. Methods A total of 320 patients (218 with CDC and 102 with nonneoplastic polyps) were enrolled. The serum BA profiles were compared between groups. Both diagnostic score of CDC and prognostic risk score of CBDS recurrence based on BAs were established by least absolute shrinkage and selection operator regression. A nomogram model was developed combining the risk score with clinical factors selected by Cox regression analysis. Results The BA profiles of patients with CDC were different from those of controls, which was mainly exhibited by an increase in conjugated BAs and the ratio of primary to secondary BA and a decrease in the hydrophobic BA ratio. The diagnostic model effectively distinguished patients with CDC from controls with an area under the curve of 0.763. Patients with CDC with a low BA risk score exhibited a high possibility of stone recurrence–free survival. The hazard ratios of history of cholecystectomy, multiple stones (n ≥ 2), bile duct angulation ≥132.7, and low BA risk score were 2.43, 4.18, 0.42, and 0.31, respectively. Conclusions The serum BA profiles were altered in patients with CDC and could be used to distinguish patients with CDC from controls. The nomogram model developed for predicting the risk of CBDS recurrence in patients with CDC after endoscopic retrograde cholangiopancreatography treatment had high accuracy and clinical usability.

Recurrence of common bile duct stones after endoscopic clearance and its predictors: A systematic review

“…Overall, 35 studies ( n = 11,771) reported the recurrence of CBD stones after initial clearance with ERCP 1–6,11–27,29–41 . The pooled event rate for the recurrence of CBD stones was 12.6% (95% confidence interval [CI]: 11.2–13.9; I 2 = 79.2%).…”

“…Figure 1 shows the PRISMA diagram for the study selection and inclusion process. A total of 37 studies with 12,952 patients were included in the final analysis 1–6,11–41 . Table 1 shows the baseline characteristics of the studies included in the present meta‐analysis, along with the study quality assessment.…”

“…However, the role of cholecystectomy in patients with BDS without gallbladder stones is controversial. Five studies reported that an in‐situ gallbladder with stones increases the risk of CBD stone recurrence, 3,4,12,17,29 while six studies reported that cholecystectomy increases the recurrence risk 3,5,11,13,36,37 . The release of the stored bile by the gallbladder in bulk has a flushing action, which prevents stone formation in the bile duct.…”

“…The most important risk factor was a CBD diameter ≥ 15 mm, which had a significant association with recurrence in 12 studies. 1,2,13,21,23,25,[29][30][31][32]38,39 Other risk factors with significant association with recurrence in three or more studies were reduced angulation of the bile duct (seven studies), 5,14,17,27,30,31,37 the presence of periampullary diverticulum (seven…”

“…Assessment of publication bias with funnel plot and (b) Bubble plot for meta-regression for the effect of duration of follow-up on heterogeneity in the recurrence of bile duct stone. studies), 1,14,16,21,22,28,31 cholecystectomy (six studies), 3,5,11,13,36,37 multiple stones in the bile duct (five studies), 22,27,30,31,37 use of mechanical lithotripsy (five studies), 3,11,24,33,41 higher age (four studies), 28,31,36,41 type I periampullary diverticulum (three studies), 6,13,26 in-situ gallbladder with stones (five studies), 3,4,12,17,29 and bile duct stent placement (three studies). 31,33,36…”