Recurrent common bile duct stones as a late complication of endoscopic sphincterotomy

Abstract

BackgroundEndoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES) has become well established as a modality for the management of common bile duct stones (CBDS), especially in the setting of associated cholangitis. Our study aims to determine the rate of long term morbidity of recurrent CBDS post ES.MethodsA retrospective analysis of patients who underwent ERCP and ES (ERCP+ES) was undertaken on a prospectively maintained database from 1998 to 2012 at the Northern Hospital, Melbourne. Primary CBDS were defined as those detected at least 6 months after complete clearance of the CBD. Prior cholecystectomy was a requirement for inclusion and patients with primary CBD stones in the setting of an intact sphincter were excluded.ResultsA total of 1148 patients underwent ERCP, of which 573 had an ES. Fifty-one patients underwent an ES prior to developing primary CBDS (8.9%). The time to recurrence ranged from 6 months to 15 years (mean 3.3 years). The number of procedures per patient ranged from 2 to 11, with 51% requiring 3 or more ERCPs. Factors associated with primary CBDS recurrence included a dilated CBD > 12 mm, stricture of the major papilla post ES to 2 - 5 mm and presence of the ampulla within or on the edge of a duodenal diverticulum.ConclusionThe results demonstrate that ERCP + ES has an inherent long-term complication of recurrent primary CBDS formation. While this can be managed with repeat ERCP, the advent of laparoscopic bile duct exploration should lead us to re-examine the role of ERCP + ES in younger patients.

Multiple recurrences after endoscopic removal of common bile duct stones: A retrospective analysis of 976 cases

“…GB left in situ with stones, which is a well‐known risk factor for CBDS recurrence, can be a cause of secondary CBDS migrated from GB, and cholecystectomy is recommended after endoscopic treatment for CBDS in cases with concurrent GB stones. Meanwhile, we believe the other two risk factors, a large bile duct and pneumobilia after treatment, can be a cause of primary CBDS as previously reported . Bile flow can be cholestatic in cases with a large common bile duct, and duodenobiliary reflux is present in cases with pneumobilia, both of which can develop primary CBDS.…”

“…Meanwhile, we believe the other two risk factors, a large bile duct and pneumobilia after treatment, can be a cause of primary CBDS as previously reported. [20][21][22][23] Bile flow can be cholestatic in cases with a large common bile duct, and duodenobiliary reflux is present in cases with pneumobilia, 24 both of which can develop primary CBDS. The evaluation of primary and secondary CBDS recurrence is essential for prevention of multiple CBDS recurrences, too.…”

Recurrence of common bile duct stones following laparoscopic common bile duct exploration: a multicenter study

“…In general, the recurrence rate of CBDS reported ranges between 4 and 25% after ERCP with EST [5]. Ding et al reported recurrent stones after the LCBDE group were lower than the ERCP with laparoscopic cholecystectomy group [6].…”

Endoscopic Endoclip Papilloplasty Preserves Sphincter of Oddi Function After Endoscopic Sphincterotomy in Porcine Models

“…Since its first application for bile stone extraction in 1974 [1,2], endoscopic sphincterotomy (EST) has been widely practiced and become a standard therapy in managing choledocholithiasis. However, there are short term and late complications of EST, such as recurrent choledocholithiasis with an incidence of 8.9%~12.3% [3][4][5][6]. Biliary bacteria reflux, surgery or EST, abnormal biliary anatomy, periampullary duodenum diverticulum, and chronic inflammation were the well-established risk factors for recurrent choledocholithiasis [7].…”