The Efficacy of Early Scheduled Follow-Up Endoscopic Retrograde Cholangiopancreatography after Common Bile Duct Stone Removal

Abstract

Background/Aims: To investigate the effi cacy of early scheduled follow-up endoscopic retrograde cholangiopancreatography (ERCP) after common bile duct (CBD) stone removal. Methods: Patients who underwent endoscopic CBD stone removal and who had at least one risk factor for stone recurrence were enrolled. Six months after complete clearance of the CBD, patients underwent follow-up ERCP at an ambulatory care center, irrespective of symptoms. Results: The incidence of symptoms and cholangitis at follow-up ERCP was signifi cantly lower in Group A (ERCP at 6 months after stone removal) than that in Group B (ERCP at >6 months) (14.3% vs 71.4%, p=0.00; 9.5% vs 33.3%, p=0.02, respectively). However, the recurrence rates of CBD stones were not different between Groups A and B (33.3% vs 47.6%). When comparing the subgroups, Group AR (stone recurrence in Group A) displayed signifi cantly fewer symptoms and lesser cholangitis and spent fewer days in the hospital than did Group BR (stone recurrence in Group B) (21.4% vs 70%, p=0.02; 14.3% vs 60%, p=0.02; 2.43±1.87 vs 6.10±3.35, p=0.00, respectively). Conclusions: Our data suggest that, irrespective of symptoms, early scheduled follow-up ERCP for patients who are at a high risk of recurrence is effective and safe. (Gut Liver 2011;5:65-69) Key Words: Risk factor; Recurrence; Common bile duct stone; Endoscopic retrograde cholangiopancreatography; Cholangitis INTRODUCTIONThe recurrence rates of common bile duct (CBD) stones after endoscopic stone removal have been reported to range from 4% to 24%. [1][2][3][4][5][6] Many risk factors for the recurrence of CBD stones such as CBD dilatation, acute CBD angulation, periampullary diverticulum (PAD), a history of cholecystectomy and the number of CBD stones have been reported. [5][6][7][8][9][10][11][12] The early detection and treatment of recurrent CBD stones may help to avoid more serious complication such as acute suppurative cholangitis. Several studies [8][9][10]13 have reported that regular clinical follow-up of patients after CBD stones removal is beneficial and it reduces the morbidity related to stone recurrence. However, early detection of CBD stone is not easy even after physical examinations, biochemical tests and ultrasonography. Furthermore, the majority of patients who are without risk factors for recurrence will have no further recurrence after stone removal. Therefore, if followup evaluations are restricted to the patients who are at a high risk for recurrence, then the cost of subsequent examinations may be reduced. In addition, if early scheduled follow-up endoscopic retrograde cholangiopancreatography (ERCP) is more accurate to detect stones and it is safer and feasible for removing the recurrent CBD stone as compared with regular clinical follow-up, then it should be the modality of choice to follow-up the patients who are at a high risk for recurrence. So, we conducted a prospective study on patients who are at a high risk for recurrence to evaluate the efficacy of early scheduled follow-up ERCP after CBD ...