Risk factors for bile duct stone recurrence after endoscopic biliary sphincterotomy

Abstract

<Background/Aims> Endoscopic biliary sphincterotomy(EST) is a well-established procedure for bile duct stone extraction. Recurrence of bile duct stones after endoscopic stone removal has been reported raging from 4 to 24%. There were several studies about risk factors for recurrent bile duct stones, but risk factors for stone recurrence were different at each study. The aims of this study were to identify the predictors the related with recurrence for bile duct stone and multiple recurrences. <Methods and Materials> A total of 198 consecutive patients (104 men, 94 women; mean age 65.3 years) who underwent successful EST for bile duct stones were evaluated. We classified these patients into non-recurrence group and recurrence group, then reclassified recurrence group into multiple recurrence group and once recurrence group. Follow up data were obtained retrospectively. The following factors were considered in the evaluation of predisposing risk factors of recurrence of bile duct stones: age, sex, serum liver enzymes and bilirubin, gall bladder status, periampullary diverticulum, number of bile duct stones, diameter of bile duct stones, diameter of bile duct, angle of common bile duct, length of EST incision, presence of pneumobilia, mechanical lithotripsy and number of ERCP procedures performed to achieve initial bile duct clearance. <Results> The overall recurrence rate of bile duct stones was 15.7% (31/198). Seven of the 31 patients with recurrent bile duct stones had multiple recurrences. Multivariate analysis identified two independent risk factors for recurrent bile duct stones: bile duct diameter (RR 7.93; 95% CI 2.09-30.07; p=0.02) and pneumobilia (RR 13.48; 95% CI 3.75-48.48; p<0.01). Especially, the presence of pneumobilia was the risk factor of multiple recurrences of bile duct stones (p=0.015). <Conclusions> Dilation of the bile duct and the presence of pneumobilia were significantly related to bile duct stone recurrence after EST and even after complete removal of stones. Above all, the presence of pneumobilia was related to multiple recurrences of bile duct stones. 1