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

Table 5 Risk factors for recurrence of choledocholithiasis proposed in the literature

Proposed risk factor	Ref.	Comment section
DBR	[19-21]	DBR
Pneumobilia	[19]	Indicative of DBR
Acute distal CBD angulation	[19]	Promotes bile stasis
CBD dilation	[19]	Promotes bile stasis
Periampullary diverticulum	[19]	Promotes bile stasis
Prior EST	[22,23]	Promotes DBR
Intact gallbladder with stones in situ	[22]	(Secondary) stone CBD migration
Billiary stricture	[22]	Promotes bile stasis
Papillary stenosis	[22]	Promotes bile stasis
ML	[22]	Small residual microlithiasis acts as nidi for stone formation
Stone size	[24]	Size of the largest stone
Cirrhosis	[22]	Delayed biliary emptying/bile stasis
Delayed biliary emptying	[22]	Promotes bile stasis
Bacterial infection/colonization of the CBD. Bacterial count	[25,26]	Promotes chronic infection, and inflammation, promotes stone formating
Impaired biliary flow	[25]	Scintigraphic study
Cholecystectomy (without stones)	[27]	Impede flushing of nidus/residual stones
Post-procedural sphincter function impaired	[6,27]	EST vs EPBD/EPLBD vs EPSBD, promote DBR
Number of sessions to clear duct at first presentation	[6]	# of ERCPs required to achieve a patent CBD
Age	[6]	Old age
Previous cholecystectomy (open or lap)	[6]
Serum lvls of chol	[24]	Lithogenic properties
EST size	[24]	Minimal size is protective
Inflammation CBD	[24]
Parasites of the CBD	[24]	Parasitic infection
Foreign bodies in the CBD	[24]
Concurrent cholecystolithiasis and cholelithiasis	[28]
Post stone removal CBD diameter	[21]	At 72 h after stones removal, cholangiogram via nasobiliary tube
EPLBD > 10 mm	[29]	Disruption of SO, DBR
Variations of the ABCB4, ABCB11 genes	[30]	Affect composition of bile. Associated with cholestasis, cholelithiasis and formation of primary intrahepatic stones
Excessive dilation of the CBD	[31]	Recurrence rate was 40% when maximum CBD diameter was more than 20 mm, whereas recurrence rate was 18% when maximum CBD diameter was 20 mm or less

The level of evidence varies. DBR: Duodenal-biliary reflux; CBD: Common bile duct; EST: Endoscopic sphincterotomy; ML: Mechanical lithotripsy; EPBD: Endoscopic papillary balloon dilation; EPLBD: Endoscopic papillary large balloon dilation; EPSBD: Endoscopic papillary small balloon dilation; ERCP: Endoscopic retrograde cholangiopancreatography; Llv: Level; Chol: Cholesterol; SO: Sphincter of Oddi.