Analysis on the risk factors of multiple recurrent common bile duct stones after endoscopic treatment

Abstract

Objective To investigate the risk factors of multiple recurrent bile duct stones in patients with common bile duct (CBD) stones and received endoscopic sphincterotomy (EST) treatment. Methods From June 1st, 2007 to June 1st, 2011, the patients received EST treatment were followed up, the follow-up time was three to seven years. A total of 2 738 patients were successfully followed up, including 24 patients with two or more than two times of recurrent bile stone after EST who were enrolled in multiple recurrence group. One hundred patients without recurrence were randomly selected by table of random number as control group. The clinical data of two groups were compared by t test or Chi-square test. The factors were analyzed with multivariate Logistic regression analysis and try to find out the risk factors of multiple recurrence. Results The comparative analysis between two groups showed that the three factors of juxtapapillary duodenal diverticula [17.0%(17/100) vs 41.7%(10/24)], history of biliary tract surgery [13.0%(13/100) vs 45.8%(11/24)] and the angle enclosed between the horizontal portion of the CBD and the horizontal plane (angleofbile duct) less than 45° [2.0%(2/100) vs 20.8%(5/24)] were statistically significant (χ2=6.914、13.37、9.595, all P<0.01). Furthermore, logistic regression analysis indicated that juxtapapillary duodenal diverticula (B=1.421, OR=4.142, P=0.01), history of biliary tract surgery (B=1.612, OR=5.011, P=0.004) and the angle of bile ductless than 45°(B=2.661, OR=14.31, P=0.005) were risk factors of multiple recurrence. Conclusion Juxtapapillary duodenal diverticula, history of biliary tract surgery, and the angle of bile duct less than 45° are independent risk factors of multiple recurrence of CBD stones. Key words: Cholangiopancreatography, endoscopic retrograde; Sphincterotomy, endoscopic; Choledocholithiasis; Multiple recurrence; Risk factors