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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Common bile duct morphology is associated with recurrence of common bile duct stones in Billroth II anatomy patients
Xu Ji, Wen Jia, Qian Zhao, Yao Wang, Shu-Ren Ma, Lu Xu, Ying Kan, Yang Cao, Bao-Jun Fan, Zhuo Yang
Xu Ji, Wen Jia, Qian Zhao, Yao Wang, Shu-Ren Ma, Lu Xu, Ying Kan, Yang Cao, Bao-Jun Fan, Zhuo Yang, Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
Xu Ji, Qian Zhao, Lu Xu, Postgraduate College, Dalian Medical University, Dalian 116044, Liaoning Province, China
Yao Wang, Bao-Jun Fan, Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang 110847, Liaoning Province, China
Ying Kan, Yang Cao, Postgraduate College, Jinzhou Medical University, Jinzhou 121001, Liaoning Province, China
Author contributions: Ji X and Yang Z contributed to drafting the final manuscript; all authors contributed to study design, data collection, statistical analysis, and reading and approving the final manuscript.
Institutional review board statement: The study was reviewed and approved by the General Hospital of Northern Theater Command Institutional Review Board.
Informed consent statement: Written informed consent was obtained from the patients or their guardian prior to the study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: Zhuo Yang, MD, Chief Doctor, Department of Digestive Endoscopy, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang 110840, Liaoning Province, China. yangzhuocy@163.com
Received: April 29, 2021
Peer-review started: April 29, 2021
First decision: May 26, 2021
Revised: June 20, 2021
Accepted: July 29, 2021
Article in press: July 29, 2021
Published online: September 16, 2021
ARTICLE HIGHLIGHTS
Research background
Endoscopic retrograde cholangiopancreatography (ERCP) is the first choice for removing common bile duct (CBD) stones in Billroth II anatomy patients. The risk factors for CBD stone recurrence after ERCP have been discussed for many years. However, CBD morphology had never been noticed as a potential risk factor.
Research motivation
Our study introduced the new concept of CBD morphology on the cholangiogram and classified it into straight type, S type, and polyline type.
Research objectives
The objective of this study was to evaluate CBD morphology and other predictors affecting CBD stone recurrence in Billroth II gastrectomy patients.
Research methods
We performed a retrospective case-control analysis of CBD stones patients with a history of Billroth II gastrectomy, and there were 138 patients who underwent therapeutic ERCP at our center from January 2011 to October 2020. We examined the possible predictors of CBD stone recurrence by univariate analysis and multivariate logistic regression analysis.
Research results
CBD morphology (P < 0.01) and CBD diameter ≥ 1.5 cm (odds ratio [OR] = 6.15, 95% confidence interval [CI]: 1.87-20.24, P < 0.01) were the two independent risk factors. Patient characteristics were not statistically significant between the recurrence and non-recurrence groups, which included age, sex, CBD diameter, largest CBD stone diameter ≥ 1.2 cm, CBD stone number ≥ 2, muddy stones, initial ampullary intervention (EST, EPBD/EPLBD, and ESBD) and cholecystectomy. In multivariate analysis, the recurrence rate of patients with S type was 16.79 times that of patients with straight type (OR = 16.79, 95%CI: 4.26-66.09, P < 0.01), the recurrence rate of patients with polyline type was 4.97 times that of patients with straight type (OR = 4.97, 95%CI: 1.42-17.38, P = 0.01), and the recurrence rate of S type patients was 3.38 times that of patients with polyline type (OR = 3.38, 95%CI: 1.07-10.72, P = 0.04).
Research conclusions
CBD morphology, especially S type and polyline type, is associated with increased recurrence of CBD stones in Billroth II anatomy patients.
Research perspectives
Future research with more samples should be undertaken to assess the association between CBD morphology and CBD stone recurrence in patients with or without Billroth II gastrectomy. And periodic surveillance and standard prophylactic therapy should be explored.
