Recurrence of choledocholithiasis following endoscopic bile duct clearance: Long term results and factors associated with recurrent bile duct stones

Abstract

AIMTo evaluate the rate of recurrence of symptomatic choledocholithiasis and identify factors associated with the recurrence of bile duct stones in patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) for bile duct stone disease.METHODSAll patients who underwent ERCP and EST for bile duct stone disease and had their bile duct cleared from 1/1/2005 until 31/12/2008 was enrolled. All symptomatic recurrences during the study period (until 31/12/2015) were recorded. Clinical and laboratory data potentially associated with common bile duct (CBD) stone recurrence were retrospectively retrieved from patients’ files.RESULTSA total of 495 patients were included. Sixty seven (67) out of 495 patients (13.5%) presented with recurrent symptomatic choledocholithiasis after 35.28 ± 16.9 mo while twenty two (22) of these patients (32.8%) experienced a second recurrence after 35.19 ± 23.2 mo. Factors associated with recurrence were size (diameter) of the largest CBD stone found at first presentation (10.2 ± 6.9 mm vs 7.2 ± 4.1 mm, P = 0.024), diameter of the CBD at the first examination (15.5 ± 6.3 mm vs 12.0 ± 4.6 mm, P = 0.005), use of mechanical lithotripsy (ML) (P = 0.04) and presence of difficult lithiasis (P = 0.04). Periampullary diverticula showed a trend towards significance (P = 0.066). On the contrary, number of stones, angulation of the CBD, number of ERCP sessions required to clear the CBD at first presentation, more than one ERCP session needed to clear the bile duct initially and a gallbladder in situ did not influence recurrence.CONCLUSIONBile duct stone recurrence is a possible late complication following endoscopic stone extraction and CBD clearance. It appears to be associated with anatomical parameters (CBD diameter) and stone characteristics (stone size, use of ML, difficult lithiasis) at first presentation.

Saline Solution Irrigation of the Bile Duct after Stone Removal Reduces the Recurrence of Common Bile Duct Stones

“…Risk factors for the recurrence of CBD stones such as the elderly patients (Keizman et al 2006a), history of prior cholecystectomy (Ando et al 2003;Keizman et al 2006b), dilated CBD (Pereira-Lima et al 1998;Ohashi et al 1999;Kim et al 2001;Keizman et al 2006b; Konstantakis et al 2017), acute CBD angulation (Keizman et al 2006b), and the presence of periampullary diverticulum (Ueno et al 2003;Keizman et al 2006b) have been identified. In addition to these patients' factors, incomplete stone clearance is demonstrated as a probable risk factor (Tsuchiya et al 2008;Konstantakis et al 2017). It has been reported that cholangiography-negative small stones persisted in 23-40% of the patients after EST and stone extraction (Ohashi et al 1999;Ang et al 2009;Endo et al 2011;Ahn et al 2018).…”

Direct Peroral Cholangioscopy in the Management of Difficult Biliary Stones: a New Tool to Confirm Common Bile Duct Clearance. Results of a Preliminary Study

“…Furthermore, difficult bile duct stones are considered a risk factor for choledocholithiasis recurrence, recognized as a late adverse event after endoscopic retrograde cholangiopancreatography (ERCP) [8][9][10]. As a result, acute conditions such as cholangitis and biliary pancreatitis may occur and require repeated ERCP examination carrying the further risk of iatrogenic adverse events [11][12][13][14].…”

Incidence of choledocholithiasis in gallstone disease

“…Eighty percent of the choledocholithiasis are secondary to the passage of stones from the gallbladder into the common bile duct (also called secondary choledocholithiasis) 1 , When the stone is formed primarily in the bile duct, called primary choledocholithiasis. It accounts for about 20% of the choledocholithiasis 2,3 .…”