Korean J Gastroenterol.  2009 Jul;54(1):36-41. 10.4166/kjg.2009.54.1.36.

Risk Factors for Recurrent Bile Duct Stones after Endoscopic Clearance of Common Bile Duct Stones

Affiliations
  • 1Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea. hongjoo3.kim@samsung.com

Abstract

BACKGROUND/AIMS
We aimed to explore the risk factors contributing to the recurrence of common bile duct (CBD) stones after successful endoscopic stone clearance, focused on the anatomical factors of CBD and presence or absence of ursodeoxycholic acid (UDCA)/Rowachol(R) medication. METHODS: One hundred fourteen patients who underwent CBD stone(s) extraction by endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy at our institution from August 2004 to January 2007 were included. Univariate and multivariate analyses for the risk factors including the distal CBD angle, length of the distal CBD arm and medication such as ursodeoxycholic acid (UDCA) and/or Rowachol(R) for recurrent CBD stone(s) were performed. RESULTS: The recurrence of CBD stone(s) was found in 22 (19.3%) patients. On univariate analysis, presence of pneumobilia, presence of type 1 or type 2 periampullary diverticulum, mechanical lithotripsy and multiple sessions of ERCP were significant contributors for the recurrence of CBD stone(s). On multivariate analysis, the presence of type 1 periampullary diverticulum (OR 7.90, 95% CI: 1.56-40.16) and multiple sessions of ERCP (OR 7.56, 95% CI: 2.21-25.87) were significant contributors. Acute distal CBD angulation (< or =135degrees), shorter distal CBD arm (< or =36 mm), technical difficulty of CBD stone(s) clearance, and the prescription of UDCA and/or Rowachol(R) were not significantly associated with the recurrence of CBD stone(s). CONCLUSIONS: The recurrence of CBD stone(s) was more commonly found in the patients group with type 1 periampullary diverticulum and multiple sessions of ERCP. Therefore, patients with these risk factors should be on regular follow up.

Keyword

Endoscopic retrograde cholangiopancreatography; Endoscopic biliary sphincterotomy; Common bile duct stone; Recurrence; Periampullary diverticulum

MeSH Terms

Aged
Cholangiopancreatography, Endoscopic Retrograde
*Common Bile Duct/radiography
Data Interpretation, Statistical
Female
Gallstones/prevention & control/radiography/*surgery
Humans
Male
Middle Aged
Prospective Studies
Recurrence
Risk Factors
*Sphincterotomy, Endoscopic
Treatment Outcome
Ursodeoxycholic Acid/pharmacology
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