Long-term follow-up of different endoscopic strategies in management of choledocholithiasis in young patients

Abstract

Objective To investigate the rate of stone recurrence in young patients with common bile duct （CBD） stones after removal of stones by different endoscopic strategies and the risk factors of re- cent and long-term CBD stone recurrence. Methods After successful CBD stones removal in one ERCP ses- sion, young patients （aging 21-45 years） with complete follow-up data were recruited to the study. They were divided into endoscopic papillary balloon dilation （EPBD） group, endoscopic sphincterotomy （EST） group and EST ＋ EPBD group according to the endoscopic approaches they experienced. The recent （ ≤3 years） and long-term （ 〉 3 years） recurrent frequencies of CBD stone were counted, and the possible risk factors were determined with multivariate logistic regression analysis. Results A total of 327 young pa- tients were followed up at a mean duration of 76. 5 months, and CBD stone re-occurred in 54 cases （16. 5% ） , among which, the recent recurrence was 35 cases （ 10. 7% ） and the long-term recurrence was 19 cases （5.8%）. The recent CBD stone recurrence rates in EPBD group and the EST group were higher than that of EST ＋ EPBD group but with no significant difference （ P all 〉 13.05 ）. The long-term CBD stone recurrence rates in EPBD group and the EST group were significantly higher than that of the EST ＋ EPBD group （P all 〈 0. 05 ）. Logistic regression analysis showed that, gallbladder stone, the maximum diameter of the stone, the stone number and mechanical lithotripsy were significantly related to the recent CBD stone recurrence （P 〈 0. 05 ）. The long-term CBD stone recurrence was significantly related to the maximum diameter of the stone and balloon dilatation alone （P 〈 0. 05 ）. Conclusion Removal of CBD stones by EPBD a- lone for young patients may preserve the papillary sphincter function, but would increase the risk of long-term CBD stone recurrence. Small endoscopic sphincterotomy plus EPBD could significantly reduce the CBD stone recurrence rate. Key words: Choledocholithiasis; Endoscopic papillary balloon dilation; Sphincterotomy, endoscopic ; Follow-up studies