Abstract
BackgroundPredictors for bile duct stone recurrence after endoscopic stone extraction have not yet been clearly defined and a study investigating naïve major duodenal papilla is warranted because studies focusing only on naïve major duodenal papilla are rare. The aim of this study was to observe the long-term outcomes of endoscopic bile duct stone extraction for naïve major duodenal papilla and to assess the predictors for recurrence.MethodsThis was a retrospective cohort study that consisted of 384 patients with naïve papilla who underwent initial endoscopic bile duct stone extraction. Patients were followed up in outpatient department subsequent to complete stone clearance. Recurrence was defined as symptomatic repeated stone formation observed at least three months after the procedure. Stone recurrence, predictors of recurrence, and the recurrence rate, depending on each endoscopic treatment for major duodenal papilla, were examined.ResultsIn this study, 34 patients (8.9%) developed stone recurrence. The median time to recurrence was 439 days. Periampullary diverticulum and multiple stones were strong predictors of bile duct stone recurrence (RR, 5.065; 95% CI, 2.435–10.539 and RR: 2.4401; 95% CI: 1.0946–5.4396, respectively). The above two factors were independent predictors of stone recurrence as per logistic regression analysis adjusted for confounders (Periampullary diverticulum: OR, 7.768; 95% CI, 3.27–18.471; multiple stones: OR, 4.144; 95% CI, 1.33–12.915). No recurrence was observed after endoscopic papillary large balloon dilatation (0/20), whereas recurrence was observed in 7 patients after endoscopic papillary balloon dilatation (7/45) and in 27 patients after endoscopic sphincterotomy (27/319). However, these differences were not statistically significant (p = 0.105).ConclusionsWe determined that the presence of periampullary diverticulum and multiple stones are strong predictors for recurrence after endoscopic stone extraction. Moreover, endoscopic papillary large balloon dilatation tended to be correlated with non-recurrence of bile duct stone.
Highlights
Techniques for endoscopic bile duct (BD) stone extraction are well established and efficacious, and the complete clearance rate of ordinary sized BD stones is approximately 92%–100% [1, 2]
Periampullary diverticulum and multiple stones were strong predictors of bile duct stone recurrence (RR, 5.065; 95% CI, 2.435–10.539 and RR: 2.4401; 95% CI: 1.0946– 5.4396, respectively)
The above two factors were independent predictors of stone recurrence as per logistic regression analysis adjusted for confounders (Periampullary diverticulum: OR, 7.768; 95% CI, 3.27–18.471; multiple stones: OR, 4.144; 95% CI, 1.33–12.915)
Summary
Techniques for endoscopic bile duct (BD) stone extraction are well established and efficacious, and the complete clearance rate of ordinary sized BD stones is approximately 92%–100% [1, 2]. Recurrence of BD stones occurs in approximately 10% of patients after endoscopic stone extraction. A study investigating naïve major duodenal papilla is warranted given that the recurrence rate of BD stones is clearly elevated in patients with a history of BD stone extraction [3]. Predictors for bile duct stone recurrence after endoscopic stone extraction have not yet been clearly defined and a study investigating naïve major duodenal papilla is warranted because studies focusing only on naïve major duodenal papilla are rare. The aim of this study was to observe the long-term outcomes of endoscopic bile duct stone extraction for naïve major duodenal papilla and to assess the predictors for recurrence
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