Endoscopy 2019; 51(04): S16
DOI: 10.1055/s-0039-1681215
ESGE Days 2019 oral presentations
Friday, April 5, 2019 08:30 – 10:30: ERCP stones Club H
Georg Thieme Verlag KG Stuttgart · New York

IS DIFFICULT CHOLEDOCHOLITHIASIS RELATED TO EARLY RECURRENCE?

C Konstantakis
1   Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
,
P Patrikakos
2   Department of Surgery, General Hospital of Patras, Patras, Greece
,
I Aggeletopoulou
1   Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
,
C Triantos
1   Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
,
K Thomopoulos
1   Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
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Publikationsdatum:
18. März 2019 (online)

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    Aims:

    To investigate if presence of difficult common bile duct (CBD) stones (CBDS) is associated with an early recurrence of CBDS following endoscopic extraction.

    Methods:

    We retrospectively analyzed data of patients who underwent ERCP/endoscopic sphincterotomy, with successful CBD clearance, during 01/01/2005 – 31/12/2008 for CBDS. Symptomatic recurrences during the study period (up to 31/12/2015) were recorded. Patients were divided into two groups depending on presence or absence of difficult choledocholithiasis (defined as large (> 10 mm)/multiple (≥3) and/or embedded stones).

    Results:

    495 patients were included. 62 patients with clinical significant recurrence were enrolled. 27/62 patients (43%) presented with difficult choledocholithiasis. They relapsed after 27.4 ± 10 months. 35/62 patients (57%) exhibited “simple” lithiasis recurring after 38.7 ± 15 months. This difference in recurrence timing was statistically significant (p = 0.003). No statistically significant differences were noted (similar “recurrence profiles”) in: Episode(s) (number) of recurrence (p = 0.579), age (p = 0.929)/sex, CBD diameter (p = 0.264), CBD angulation scores (p = 0.276/0.525), interval between recurrence episodes (36 ± 24 vs. 32 ± 21, p = 0.697). Patients with difficult lithiasis required more frequently multiple ERCP sessions (p = 0.043). The main risk factor associated with an early recurrence (≤24 months after baseline ERCP) was the presence of difficult lithiasis at first presentation (p = 0.007).

    Conclusions:

    Difficult CBD lithiasis at first presentation appears to be a risk factor for early recurrence. It is likely that the underlying mechanism of early CBDS recurrence differs from that of the late one (> 24months). Late recurrence has been associated with Duodenal – Biliary Reflux and bile stasis. Patients with an “unfavorable stone profile” are at greater risk for residual microlithiasis, as confirmed by EUS studies, which could act as nidus for re-accumulation of lithiasic content. Microlithiasis/sludge could elude the imaging sensitivity of classical cholangiography.


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