New common bile duct morphological subtypes: Risk predictors of common bile duct stone recurrence

Xu Ji; Zhuo Yang; Shu-Ren Ma; Wen Jia; Qian Zhao; Lu Xu; Ying Kan; Yang Cao; Yao Wang; Bao-Jun Fan

doi:10.4240/wjgs.v14.i3.236

New common bile duct morphological subtypes: Risk predictors of common bile duct stone recurrence

World J Gastrointest Surg. 2022 Mar 27;14(3):236-246. doi: 10.4240/wjgs.v14.i3.236.

Authors

Xu Ji¹, Zhuo Yang², Shu-Ren Ma¹, Wen Jia¹, Qian Zhao¹, Lu Xu¹, Ying Kan¹, Yang Cao¹, Yao Wang¹, Bao-Jun Fan¹

Affiliations

¹ Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China.
² Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China. yangzhuocy@163.com.

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is the primary treatment for removing common bile duct (CBD) stones. The risk factors for CBD stone recurrence after ERCP have been discussed for many years. However, the influence of CBD morphology has never been noticed.

Aim: To evaluate CBD morphology and other predictors affecting CBD stone recurrence in average patients.

Methods: A retrospective analysis of 502 CBD stone patients who underwent successful therapeutic ERCP for stone extraction at our centre from February 2020 to January 2021 was conducted. CBD morphology and other predictors affecting CBD stone recurrence were examined by univariate analysis and multivariate logistic regression analysis.

Results: CBD morphology (P < 0.01), CBD diameter ≥ 1.5 cm [odds ratio (OR) = 2.20, 95%CI: 1.08-4.46, P = 0.03], and endoscopic biliary sphincterotomy with balloon dilation (ESBD) (OR = 0.35, 95%CI: 0.17-0.75, P < 0.01) are three independent risk factors for CBD stone recurrence. Furthermore, the recurrence rate of patients with the S type was 6.61-fold that of patients with the straight type (OR = 6.61, 95%CI: 2.61-16.77, P < 0.01). The recurrence rate of patients with the polyline type was 2.45-fold that of patients with the straight type (OR = 2.45, 95%CI: 1.14-5.26, P = 0.02). The recurrence rate of S type patients was 2.70-fold that of patients with the polyline type (OR = 2.70, 95%CI: 1.08-6.73, P = 0.03). Compared with no-ESBD, ESBD could decrease the risk of recurrence.

Conclusion: CBD diameter ≥ 1.5 cm and CBD morphology, especially S type and polyline type, were associated with increased recurrence of CBD stones. In addition, ESBD was related to decreased recurrence. Patients with these risk factors should undergo periodic surveillance and standard prophylactic therapy.

Keywords: Common bile duct morphology; Common bile duct stones; Endoscopic retrograde cholangiopancreatography; Recurrence; Risk factors.