Endoscopy 2020; 52(S 01): S302
DOI: 10.1055/s-0040-1704965
ESGE Days 2020 ePoster presentations
Colon and rectum 09:00–17:00 Thursday, April 23, 2020 ePoster area
© Georg Thieme Verlag KG Stuttgart · New York

RISK FACTORS FOR RECURRENCE OF STONE AFTER COMMON BILE DUCT STONES REMOVAL

HJ Kim
1   Korea University Guro Hospital, Korea University College of Medicine, Division of Gastroenterology, Department of Internal Medicine, Seoul, Korea, Republic of
,
JS Kim
1   Korea University Guro Hospital, Korea University College of Medicine, Division of Gastroenterology, Department of Internal Medicine, Seoul, Korea, Republic of
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    Aims Recurrent common bile duct stones (CBDS) after treatment by endoscopic sphincterotomy (ES) is not rare. Although loss of the function of sphincter or papillary stenosis and bile stasis may be an important factor contributing to the recurrence of CBDS, long-term complication of large ES remains controversial. The aim of this study was to compare the clinical characteristics in patients with or without recurrent CBDS after complete ES treatment.

    Methods From January 2015 to December 2015, consecutive patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for CBDS removal in Korea University Guro hospital were included, if they met all of the following criteria: (i) age 18 years or more, (ii) were undergoing their first trial of ERCP, (iii) multiple CBDS more than two were removed completely, (iv) had undergone only ES without EPBD, and v) followed over 3 year. Enrolled patients were divided into recurrence group and no recurrence group according to the CBDS recurrence. Complete ES was classified to under-ES or over-ES by incised opening of bile duct after extraction of stone; under-ES was defined when opening of bile duct is under the duodenal wall and over-ES was defined when opening is extended the duodenal wall.

    Results A total of 84 patients were included, with 24 patients in recurrence group and 60 patients in no recurrence group. Recurrence group was more female proportion and older age. The number of patients with gallstones and undergoing cholecystectomy during treatment period did not differ in the two groups. Also periampullary diverticulum was quite frequent in the both group, 58% and 48%. Diameter of CBD after stone extraction was larger in recurrence group than no recurrence group (p = 0.029). Over-ES was in 71 % of recurrence group and 43% of non-recurrence group (p < 0.05) and over-ES was shown in all 11 patients who recurred more than 3 times.

    Conclusions Post-ES large bile duct opening was related with recurrence of CBD stone. In patients with multiple large stones and dilated CBD, stone removal by complete ES alone is cautioned.


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