4637 Clinical characteristics and predictive factors of recurrent common bile duct stones after clearance of stones with endoscopic sphincterotomy.

Abstract

BACKGROUND: Endoscopic sphincterotomy (EST) for stone removal is the treatment of choice for CBD stones. Unfortunately, loss of the sphincter mechanism might lead to late complications after EST. Bile duct stones recurred in 2-13.8% of patients after bile duct clearance with endoscopic or surgical stone removal. The factors affecting the recurrent stones are still controversial. AIMS: To evaluate the clinical findings and to find out the factors which may affect the recurrent CBD stones in patients after complete clearance of bile duct with EST. MATERIALS AND METHODS: Endoscopic removal of CBD stones with EST was performed on 424 patients with CBD stones, without IHD stones. Clinical and sonographic follow up searching for recurrent stones were performed every 6 to 12 months for a 1 to 7.5 years (median: 4.6) follow-up period. 45 patients were identified to have recurrent CBD stones (group A). Control (group B) had 204 patients who underwent endoscopic removal of CBD stones with EST, without recurrence of stones. RESULTS: 1) Bile duct stones recurred in 45 patients (10.6 %) after EST for stone removal with 11 of the 45 patients (24.4%) having two or more recurrences. 2) The median time from EST to the recurrence was 31.7 months (ranges: 6-106). Most (73.4%) of the recurrent bile duct stones occurred within 3 years after EST. 3) Periampullary duodenal diverticula (PADD) (A:64.4%, B:46.6%), biliary stricture (A:48.8%, B:17.6%), and fragmentation of initial stones (A:42.2%, B:18.6%) showed a significant relationship with the recurrence. 4) Initially large stones, biliary stricture, and PADD were related significantly to the multiple recurrences. 5) Septic complications were higher in patients with recurrence of stones. 6) Three cases of cholangiocarcinoma, and 7 cases of IHD stones developed during the follow-up in patients with recurrent stones. 7) 93.3% of recurrent stones in the bile duct were successfully removed by endoscopy. CONCLUSIONS: PADD, biliary stricture, and fragmentation of initial bile duct stones were contributing factors in the development of recurrent bile duct stones in patients with CBD stones after complete bile duct clearance with EST. Careful follow-up and prompt stone removal should be considered for patients with these factors for preventing serious complications.