Tu1954 Risk Factors of Recurrence of Common Bile Duct Stones After Removing With Endoscopic Papillary Large Balloon Dilatation

Abstract

Background/Aims: Endoscopic papillary large balloon dilation (EPLBD) can be used as a treatment of removing the difficult common bile duct (CBD) stone. However, we still experience cases of recurrence after an EPLBD. The aim of this study was to evaluate the risk factors of recurrence of CBD stone after an EPLBD. Methods: From March 2004 to October 2010, a total of 262 patients with CBD stones were treated by EPLBD at Gangnam Severance and Daegu Catholic University Hospital. Clinical and endoscopic parameters were analyzed to determine the risk factors of CBD stone recurrence. Results: Of the 262 patients (men 100, women 162, mean age 72.0±11.8 years), the recurrence rate was 19.8% ( 52/ 262). Mean duration between treatment and recurrence was 13.5 months (1.4~64.8 months). In univariate analysis, multiple stones (≥3), large stone (≥14mm), diameter of the CBD (≥ 20mm), and angulated CBD (angle≤145°) were identified as the significant predictors of recurrence. In multivariate analysis, multiple stones (≥3, P=0.015, OR 2.26, 95% CI 1.174.36), diameter of CBD (≥ 20mm, P < 0.001, OR 4.67, 95% CI 2.23-9.80) and angulated CBD (angle≤145°, P < 0.001, OR 4.98, 95% CI 2.36-10.54) were identified as the significant predictors of recurrence. Gender, age, periampullary diverticulum and previous cholecystectomy did not influence the recurrence rate. Conclusions: The recurrence of CBD stone after EPLBD was strongly associated with multiple stones (≥3), diameter of the CBD (≥ 20mm), and angulated CBD (angle≤145°). Close and meticulous follow-up may be required in patients with these parameters.