Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2019; 7(9): 1028-1037
Published online May 6, 2019. doi: 10.12998/wjcc.v7.i9.1028
Causes associated with recurrent choledocholithiasis following therapeutic endoscopic retrograde cholangiopancreatography: A large sample sized retrospective study
Feng Deng, Mi Zhou, Ping-Ping Liu, Jun-Bo Hong, Guo-Hua Li, Xiao-Jiang Zhou, You-Xiang Chen
Feng Deng, The First Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China
Mi Zhou, Medical College of Nanchang University, Nanchang 330000, Jiangxi Province, China
Ping-Ping Liu, Department of Gastroenterology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou 341000, Jiangxi Province, China
Jun-Bo Hong, Guo-Hua Li, Xiao-Jiang Zhou, You-Xiang Chen, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China
Author contributions: Deng F and Zhou M contributed equally to the study and share the primary authorship of this article; Deng F and Zhou M conceptualized and designed the study and wrote the manuscript; Liu PP collected the data; Hong JB made critical revisions to the manuscript; Li GH helped in interpreting and analyzing the data; Zhou XJ and Chen YX made substantial contributions to the conception, design, and coordination of the study and gave final approval of the version to be published; all authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of the First Affiliated Hospital of Nanchang University.
Informed consent statement: All involved subjects gave their informed consent (written or verbal) prior to study inclusion.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xiao-Jiang Zhou, PhD, Associate Professor, Chief Doctor, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng Street, Nanchang 330000, Jiangxi Province, China. yfyzxj1970@163.com
Telephone: +86-791-88692540 Fax: +86-791-86292217
Received: February 16, 2019
Peer-review started: February 18, 2019
First decision: March 5, 2019
Revised: March 15, 2019
Accepted: March 26, 2019
Article in press: March 26, 2019
Published online: May 6, 2019
Abstract
BACKGROUND

Recurrence of primary choledocholithiasis commonly occurs after complete removal of stones by therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The potential causes of the recurrence of choledocholithiasis after ERCP are unclear.

AIM

To analyze the potential causes of the recurrence of choledocholithiasis after ERCP.

METHODS

The ERCP database of our medical center for the period between January 2007 and January 2016 was retrospectively reviewed, and information regarding eligible patients who had choledocholithiasis recurrence was collected. A 1:1 case-control study was performed for this investigation. Data including general characteristics of the patients, past medical history, ERCP-related factors, common bile duct (CBD)-related factors, laboratory indicators, and treatment was analyzed by univariate and multivariate logistic regression analysis and Kaplan-Meier analysisly.

RESULTS

First recurrence of choledocholithiasis occurred in 477 patients; among these patients, the second and several instance (≥ 3 times) recurrence rates were 19.5% and 44.07%, respectively. The average time to first choledocholithiasis recurrence was 21.65 mo. A total of 477 patients who did not have recurrence were selected as a control group. Multivariate logistic regression analysis showed that age > 65 years (odds ratio [OR] = 1.556; P = 0.018), combined history of choledocholithotomy (OR = 2.458; P < 0.01), endoscopic papillary balloon dilation (OR = 5.679; P = 0.000), endoscopic sphincterotomy (OR = 3.463; P = 0.000), CBD stent implantation (OR = 5.780; P = 0.000), multiple ERCP procedures (≥2; OR = 2.75; P = 0.000), stones in the intrahepatic bile duct (OR = 2.308; P = 0.000), periampullary diverticula (OR = 1.627; P < 0.01), choledocholithiasis diameter ≥ 10 mm (OR = 1.599; P < 0.01), bile duct-duodenal fistula (OR = 2.69; P < 0.05), combined biliary tract infections (OR = 1.057; P < 0.01), and no preoperative antibiotic use (OR = 0.528; P < 0.01) were independent risk factors for the recurrence of choledocholithiasis after ERCP.

CONCLUSION

Patient age greater than 65 years is an independent risk factor for the development of recurrent choledocholithiasis following ERCP, as is history of biliary surgeries, measures during ERCP, and prevention of postoperative complications.

Keywords: Choledocholithiasis, Endoscopic retrograde cholangiopancreatography, Recurrence, Common bile duct

Core tip: The potential causes of the recurrence of choledocholithiasis after endoscopic retrograde cholangiopancreatography (ERCP) are unclear. By a large sample sized retrospective study of 954 patients, we concluded that patient age greater than 65 years is an independent risk factor for the development of recurrent choledocholithiasis following ERCP, as is history of biliary surgeries, measures during ERCP, and prevention of postoperative complications.