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Kozyk M, Giri S, Harindranath S, Trivedi M, Strubchevska K, Barik RK, Sundaram S. Recurrence of common bile duct stones after endoscopic clearance and its predictors: A systematic review. DEN OPEN 2024; 4:e294. [PMID: 37818098 PMCID: PMC10560705 DOI: 10.1002/deo2.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/10/2023] [Accepted: 08/25/2023] [Indexed: 10/12/2023]
Abstract
Background The primary therapeutic strategy for the management of bile duct stones (BDS) is endoscopic retrograde cholangiopancreatography. However, there may be a recurrence of BDS on follow-up. Multiple risk factors have been studied for the prediction of BDS recurrence. We aimed to analyze the incidence of symptomatic BDS recurrence, systematically review the risk factors, and analyze the most important risk factors among those. Methods A comprehensive search of three databases was conducted from inception to November 2022 for studies reporting the recurrence of BDS recurrence after endoscopic retrograde cholangiopancreatography with clearance, along with an analysis of risk factors. Results A total of 37 studies with 12,952 patients were included in the final analysis. The pooled event rate for the recurrence of BDS stones was 12.6% (95% confidence interval: 11.2-13.9). The most important risk factor was a bile duct diameter ≥15 mm, which had a significant association with recurrence in twelve studies. Other risk factors with significant association with recurrence in three or more studies were the reduced angulation of the bile duct, the presence of periampullary diverticulum, type I periampullary diverticulum, in-situ gallbladder with stones, cholecystectomy, multiple stones in the bile duct, use of mechanical lithotripsy, and bile duct stent placement. Conclusion Around one out of seven patients have BDS recurrence after the initial endoscopic retrograde cholangiopancreatography. Bile duct size and anatomy are the most important predictors of recurrence. The assessment of risk factors associated with recurrence may help keep a close follow-up in high-risk patients.
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Affiliation(s)
- Marko Kozyk
- Department of Internal MedicineCorewell Health William Beaumont University HospitalRoyal OakMichiganUSA
| | - Suprabhat Giri
- Department of Gastroenterology & HepatologyKalinga Institute of Medical SciencesBhubaneswarIndia
| | | | - Manan Trivedi
- Department of General SurgeryKB Bhabha HospitalMumbaiIndia
| | - Kateryna Strubchevska
- Department of Internal MedicineCorewell Health William Beaumont University HospitalRoyal OakMichiganUSA
| | - Rakesh Kumar Barik
- Department of GastroenterologyIndian Institute of Gastroenterology and HepatologyCuttackIndia
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical NutritionTata Memorial HospitalMumbaiIndia
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Wu Y, Zhang Y, Jiang XM, Xu CJ, Wang YY, Gu JY, Li Y, Xu SF. Risk Factors for Single and Multiple Recurrences for Endoscopic Retrograde Cholangiopancreatography and Open Choledochotomy in Treating Choledocholithiasis. Gastroenterol Res Pract 2023; 2023:4738985. [PMID: 37941974 PMCID: PMC10630008 DOI: 10.1155/2023/4738985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 06/29/2023] [Accepted: 10/14/2023] [Indexed: 11/10/2023] Open
Abstract
Background There are few studies comparing recurrences between endoscopic retrograde cholangiopancreatography (ERCP) and open choledochotomy (OCT). Aims To compare the effect of different surgical methods on single and multiple recurrences of choledocholithiasis. Methods A total of 1255 patients with choledocholithiasis who underwent ERCP or OCT were retrospectively studied. The recurrence of choledocholithiasis was calculated by the Kaplan-Meier method with the log-rank test. Multivariate analyses of recurrent choledocholithiasis were performed by introducing variables with P < 0.20 in univariate analysis into the logistic regression model. Results A total of 204 (16.7%, 204/1225) patients relapsed. Among the 204 patients, 74.5% relapsed within three years after surgery, of whom 39.7% (81/204) had multiple relapses (≥ 2). The recurrence rate of ERCP (17.2%, 119/692) was higher than that of OCT (15.1%, 85/563), but the difference was not statistically significant. The independent risk factors for a single recurrence of choledocholithiasis were diabetes, stone number ≥ 2, maximum stone diameter ≥ 15 mm, sedentary occupation, the approach of ERCP (EST or EPBD), periampullary diverticulum, primary suture, high-fat diet (postoperative), frequency of weekly vegetable intake (< 4, postoperative), and drinking (postoperative). However, the ERCP approach (EST or EPBD), OCT approach (LCBDE), primary suture, high-fat diet (postoperative), and frequency of weekly vegetable intake (< 4, postoperative) were independent risk factors for multiple recurrences of choledocholithiasis. Conclusion Patients with choledocholithiasis should be followed up regularly for one to three years after treatment. Stone number ≥ 2, diabetes mellitus, periampullary diverticulum, surgical methods, and lifestyle are all risk factors for the recurrence of choledocholithiasis. ERCP is still the preferred surgical method based on the advantages of low risk of cholangitis recurrence, less hospital stay, minimally invasive surgery, fewer postoperative complications, and easier acceptance by elderly patients. In addition to optimizing the treatment plans, postoperative lifestyle management is also vital.
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Affiliation(s)
- Yao Wu
- Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, China
| | - Ying Zhang
- School of Public Health, Southeast University, Nanjing 211189, China
| | - Xiao Meng Jiang
- Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, China
| | - Chen Jing Xu
- Jiangsu Province Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Yan Yan Wang
- Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, China
| | - Jin Yuan Gu
- Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, China
| | - Yi Li
- Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, China
| | - Shun Fu Xu
- Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, China
- Jiangsu Province Hospital, Nanjing Medical University, Nanjing 210029, China
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3
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Hess GF, Sedlaczek P, Zeindler J, Muenst S, Schmitt AM, Däster S, Bolli M, Kollmar O, Soysal SD. The short- and long-term outcome after the surgical management of common bile duct stones in a tertiary referral hospital. Langenbecks Arch Surg 2023; 408:288. [PMID: 37515739 PMCID: PMC10386922 DOI: 10.1007/s00423-023-03011-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/02/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND The removal of common bile duct stones by endoscopic retrograde cholangiopancreatography (ERCP) shows excellent results with low complication rates and is therefore considered a gold standard. However, in case of stones non-removable by ERCP, surgical extraction is needed. The surgical approach is still controversial and clinical guidelines are missing. This study aims to analyze the outcomes of patients treated with choledochotomy or hepaticojejunostomy for common bile duct stones. METHODS All patients who underwent choledochotomy or hepaticojejunostomy for common bile duct stones at a tertiary referral hospital over 11 years were included. The analyzed data contains basic demographics, diagnostics, surgical parameters, length of hospitalization, and morbidity and mortality. RESULTS Over the study period, 4375 patients underwent cholecystectomy, and 655 received an ERCP with stone extraction, with 48 of these patients receiving subsequent surgical treatment. ERCP was attempted in 23/30 (77%) of the choledochotomy patients pre/intraoperatively and 11/18 (56%) in hepaticojejunostomy patients. The 30-day major complication rate (Clavien-Dindo > II) was 1/30 (3%) in the choledochotomy group and 2/18 (11%) in the hepaticojejunostomy group. Complications after 30 days occurred in 3/30 (10%) patients and 2/18 (11%), respectively, and no mortality occurred. CONCLUSION ERCP should still be considered the gold standard, although due to low short- and long-term morbidity rates, choledochotomy and hepaticojejunostomy represent effective surgical solutions for common bile duct stones.
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Affiliation(s)
- Gabriel F Hess
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Philipp Sedlaczek
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - Jasmin Zeindler
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Simone Muenst
- Institute of Medical Genetics and Pathology University Hospital Basel, Schönbeinstrasse 40, 4056, Basel, Switzerland
| | - Andreas M Schmitt
- Department of Internal Medicine, Medical Oncology, University Hospital Basel, Petersgraben 4, 4051, Basel, Switzerland
| | - Silvio Däster
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Martin Bolli
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Otto Kollmar
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Savas D Soysal
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland.
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4
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Huang L, Xu Y, Chen J, Liu F, Wu D, Zhou W, Wu L, Pang T, Huang X, Zhang K, Yu H. An artificial intelligence difficulty scoring system for stone removal during ERCP: a prospective validation. Endoscopy 2023; 55:4-11. [PMID: 35554877 DOI: 10.1055/a-1850-6717] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND A computer-assisted (CAD) system was developed to assess, score, and classify the technical difficulty of common bile duct (CBD) stone removal during endoscopic retrograde cholangiopancreatography (ERCP). The efficacy of the CAD system was subsequently assessed through a multicenter, prospective, observational study. METHOD All patients who met the inclusion criteria were included. Based on cholangiogram images, the CAD system analyzed the level of difficulty of stone removal and classified it into "difficult" and "easy" groups. Subsequently, differences in clinical endpoints, including attempts at stone extraction, stone extraction time, total operation time, and stone clearance rates were compared between the two groups. RESULTS 173 patients with CBD stones from three hospitals were included in the study. The group classified as difficult by CAD had more extraction attempts (7.20 vs. 4.20, P < 0.001), more frequent machine lithotripsy (30.4 % vs. 7.1 %, P < 0.001), longer stone extraction time (16.59 vs. 7.69 minutes, P < 0.001), lower single-session stone clearance rate (73.9 % vs. 94.5 %, P < 0.001), and lower total stone clearance rate (89.1 % vs. 97.6 %, P = 0.019) compared with the group classified as easy by CAD. CONCLUSION The CAD system effectively assessed and classified the degree of technical difficulty in endoscopic stone extraction during ERCP. In addition, it automatically provided a quantitative evaluation of CBD and stones, which in turn could help endoscopists to apply suitable procedures and interventional methods to minimize the possible risks associated with endoscopic stone removal.
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Affiliation(s)
- Li Huang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Youming Xu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jie Chen
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Feng Liu
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Deqing Wu
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Zhou
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lianlian Wu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tingting Pang
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xu Huang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Kuo Zhang
- Wuhan ENDOANGEL Medical Technology Company, Wuhan, China
| | - Honggang Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
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5
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Lu Z, Zhao H. Preferable timing of intraductal ultrasonography during endoscopic retrograde cholangiopancreatography lithotomy: A prospective cohort study. Front Med (Lausanne) 2022; 9:1042929. [DOI: 10.3389/fmed.2022.1042929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
AimIntraductal ultrasonography (IDUS) is a highly sensitive and non-invasive detective method that can be used to detect complete calculus clearance during endoscopic retrograde cholangiopancreatography (ERCP). In this study, we examined the preferable timing of IDUS during ERCP lithotomy.MethodsFrom 2017 to 2020, patients with choledocholithiasis were randomized into IDUS-BL (IDUS performed before lithotomy) group, IDUS-ALC (cholangiography and IDUS performed after lithotomy) group, and IDUS-AL group (IDUS performed after lithotomy) group. The influence of IDUS on the accuracy of prejudgment, the incidence of residual stones, the need for repeated lithotomy (RL), and fluoroscopy time were analyzed.ResultsA total of 184 patients were enrolled. No residual stones were found during follow-up in any of the three groups. There was no difference in prejudgment accuracy rate on size and number of stones between different groups (all P > 0.05). RL were performed in 5, 9, and 9 cases of IDUS-BL, IDUS-ALC, and IDUS-AL group, respectively (P > 0.05). IDUS-AL group had a shorter fluoroscopy time than the other two groups (1.5 ± 0.6 vs. 2.8 ± 1.2, 2.5 ± 1.0 min, P < 0.05). Incidence of RL was related to the location of calculus [middle or lower part of common bile duct (CBD)], lithotripsy, dilated CBD (2.12 ± 0.46 vs. 1.78 ± 0.40 cm, P < 0.01), and inaccuracy prejudgment.ConclusionIDUS performed after lithotomy is preferable for shorten fluoroscopy time during ERCP. IDUS is a reliable solution for the stone omission, which may be more valuable for patients with high-risk factors of RL.
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CRP and ALT Levels in Individuals with Acute Biliary Pancreatitis after Endoscopic Retrograde Cholangiopancreatography and Endoscopic Sphincterotomy. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:6492551. [PMID: 35726289 PMCID: PMC9206583 DOI: 10.1155/2022/6492551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/24/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022]
Abstract
Objective The goal of this study was to see how effective endoscopic retrograde cholangiopancreatography combined with endoscopic sphincterotomy was in treating acute biliary pancreatitis and how it affected CRP and ALT levels. Methods This analysis is based on a 100-patient acute pancreatitis (ABP) study conducted at our institution from June 2019 to June 2020. They were divided into two groups of 50 cases each, the control group and the observational group, according to the random number table. Endoscopic sphincterotomy and ERCP were performed on the observation group instead of open surgery on the control group as a point of comparison (EST). The followings were compared including abdominal pain relief duration, blood amylase recovery duration, and hospital stay duration, as well as Serum C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) level; the ALT, AST, and GGT levels of the two groups were compared, as well as the occurrence of problems in both groups. Results The observation group had a significantly shorter duration of abdominal pain, blood amylase recovery, and hospital stay. Presurgery CRP, IL-6, and TNF-α levels in both groups were significantly lower in the observation group than in the control group. According to the results of the study, both groups saw significant decreases in ALT, AST, and GGT after surgery; however, the levels of these markers in both groups were significantly lower in the observation group after surgery than in the control group. The observation group's (14.00 percent) complication rate was substantially lower. Conclusion ERCP and EST in the treatment of ABP can not only successfully improve clinical indexes and facilitate the recovery of patients but also reduce the levels of CRP and alt, reduce the level of inflammation, and enhance renal function, with reduced problems, which has a high clinical reference value.
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Ji X, Yang Z, Ma SR, Jia W, Zhao Q, Xu L, Kan Y, Cao Y, Wang Y, Fan BJ. New common bile duct morphological subtypes: Risk predictors of common bile duct stone recurrence. World J Gastrointest Surg 2022; 14:236-246. [PMID: 35432763 PMCID: PMC8984516 DOI: 10.4240/wjgs.v14.i3.236] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/12/2021] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
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.
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Affiliation(s)
- Xu Ji
- Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
- Postgraduate College, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Zhuo Yang
- Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Shu-Ren Ma
- Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Wen Jia
- Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Qian Zhao
- Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Lu Xu
- Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Ying Kan
- Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Yang Cao
- Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Yao Wang
- Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Bao-Jun Fan
- Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
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Is the use of fully covered metal stents effective in the treatment of difficult lithiasis of the common bile duct? Surg Endosc 2022; 36:5684-5691. [PMID: 34993589 DOI: 10.1007/s00464-021-08919-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 11/21/2021] [Indexed: 12/07/2022]
Abstract
BACKGROUND The management of difficult lithiasis of common bile duct (CBD) often requires a multimodal approach. Fully Covered Metal Stents (FCSEMS) could fragment the stones, dilate strictures of the CBD and progressively enlarge the papillary orifice. The aim of the study was to evaluate the efficacy of FCSEMS in the treatment of difficult lithiasis of CBD. METHODS All consecutive cases of difficult lithiasis of CBD after an attempt of clearance with complete sphincterotomy were retrospectively considered from 2009 to 2019. Intrahepatic lithiasis cases were excluded. Multivariable analysis (stepwise logistic regression if p value < 0.1 at univariable analysis) was made to understand factors associated with efficacy of FCSEMS in difficult lithiasis of CBD. RESULTS 163 cases of difficult lithiasis over 1516 cases of lithiasis of CBD (incidence of 11%) were considered. Among eligible patients, 96 (mean age 78 ± 11.9 years, 43% males) placed a FCSEMS during the first ERCP. Mean diameter of stone was 17.5 ± 5.5 mm. An attempt of dilation during the same procedure was made in 18% cases. After removal of the stent, 52 (54%) patients had complete clearance of CBD at cholangiography. The rest of patients (44), subsequently underwent multimodal treatment (final success of 95%). After logistic regression, variables positively associated with clearance of CBD were sex male (OR 3.5) and stent permanence ≥ 30 days (OR 3.2). Diameter of the stone ≥ 2 cm was associated with failure (OR 0.2). 7 post-ERCP pancreatitis, 6 post-sphincterotomy bleeding and 3 cholangitis occurred. CONCLUSIONS FCSEMS are useful in the approach of difficult lithiasis of CBD with no significant adverse events associated.
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Ji X, Jia W, Zhao Q, Wang Y, Ma SR, Xu L, Kan Y, Cao Y, Fan BJ, Yang Z. Common bile duct morphology is associated with recurrence of common bile duct stones in Billroth II anatomy patients. World J Clin Cases 2021; 9:7671-7681. [PMID: 34621818 PMCID: PMC8462226 DOI: 10.12998/wjcc.v9.i26.7671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/20/2021] [Accepted: 07/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is the primary choice for removing common bile duct (CBD) stones in Billroth II anatomy patients. The recurrence of CBD stones is still a challenging problem.
AIM To evaluate CBD morphology and other predictors affecting CBD stone recurrence.
METHODS A retrospective case-control analysis was performed on 138 CBD stones patients with a history of Billroth II gastrectomy, who underwent therapeutic ERCP for stone extraction at our center from January 2011 to October 2020. 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) and CBD diameter ≥ 1.5 cm (odds ratio [OR] = 6.15, 95% confidence interval [CI]: 1.87-20.24, P < 0.01) were the two independent risk factors. In multivariate analysis, the recurrence rate of patients with S type was 16.79 times that of patients with straight type (OR = 16.79, 95%CI: 4.26-66.09, P < 0.01), the recurrence rate of patients with polyline type was 4.97 times that of patients with straight type (OR = 4.97, 95%CI: 1.42-17.38, P = 0.01), and the recurrence rate of S type patients was 3.38 times that of patients with polyline type (OR = 3.38, 95%CI: 1.07-10.72, P = 0.04).
CONCLUSION CBD morphology, especially S type and polyline type, is associated with increased recurrence of CBD stones in Billroth II anatomy patients.
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Affiliation(s)
- Xu Ji
- Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
- Postgraduate College, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Wen Jia
- Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Qian Zhao
- Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
- Postgraduate College, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Yao Wang
- Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
- Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang 110847, Liaoning Province, China
| | - Shu-Ren Ma
- Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Lu Xu
- Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
- Postgraduate College, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Ying Kan
- Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
- Postgraduate College, Jinzhou Medical University, Jinzhou 121001, Liaoning Province, China
| | - Yang Cao
- Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
- Postgraduate College, Jinzhou Medical University, Jinzhou 121001, Liaoning Province, China
| | - Bao-Jun Fan
- Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
- Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang 110847, Liaoning Province, China
| | - Zhuo Yang
- Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
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Ryu S, Jo IH, Kim S, Kim YJ, Chung WC. Clinical Impact of Common Bile Duct Angulation on the Recurrence of Common Bile Duct Stone: A Meta-analysis and Review. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 76:199-205. [PMID: 33100315 DOI: 10.4166/kjg.2020.76.4.199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 02/06/2023]
Abstract
Background/Aims Local and systemic factors, such as diabetes, obesity, and hyperlipidemia, are considered risk factors for the recurrence of choledocholithiasis after successful endoscopic clearance. Local factors include the presence of bile sludge, common bile duct (CBD) diameter, and CBD angulation. Among them, it is unclear if acute CBD angulation is preferable to the recurrence of a CBD stone. Methods PubMed, EMBASE, CINAHL, the Cochrane Library databases, and google website were searched for randomized controlled trials reported in English and undertaken until August 2019. Meta-analysis was performed on all randomized controlled trials for the recurrence of CBD stones between the patients with acute CBD angulation. Results Eight randomized trials (1,776 patients) were identified, and the total recurrent rate of CBD stones was 18.8% (334/1,776). A CBD angle ≤145° was significantly associated with an increased risk of recurrent CBD stone (OR=2.65, p<0.01). In two prospective studies, acute CBD angulation was not proven to be associated with a recurrence (p=0.39). Conclusions Approximately 20% of patients with a CBD stone showed recurrence after the complete clearance of the CBD stone, and a CBD angle ≤145° could increase the risk of recurrence. Overall, a large-scale prospective study should be necessary.
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Affiliation(s)
- Seongyul Ryu
- Division of Gastroenterology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ik Hyun Jo
- Division of Gastroenterology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Seonhoo Kim
- Division of Gastroenterology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Yeon-Ji Kim
- Division of Gastroenterology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Woo Chul Chung
- Division of Gastroenterology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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11
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Shen H, Zhu J, Ye F, Xu D, Fang L, Yang J, Lv H, Lou Q, Jin H, Ni M, Zhang X. Biliary Microbial Structure of Gallstone Patients With a History of Endoscopic Sphincterotomy Surgery. Front Cell Infect Microbiol 2021; 10:594778. [PMID: 33585269 PMCID: PMC7873689 DOI: 10.3389/fcimb.2020.594778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/09/2020] [Indexed: 11/13/2022] Open
Abstract
The biliary microbiota is related to the pathogenesis of human bile duct stones. However, the extent to which a history of invasive endoscopic sphincterotomy (EST) affects the biliary bacterial community remains largely unknown. We collected bile samples from the common bile duct of 100 choledocholithiasis patients. We performed 16S rRNA sequencing to investigate and compare the biliary microbial community. The patients without antibiotic treatment (AT) were grouped into three clusters based on their biliary microbial compositions. The patients with a history of EST were significantly enriched in one cluster mainly consisting of gastrointestinal bacteria compared with the other two clusters consisting of oral and environmental bacteria. The β-diversities of patients with and without EST were also significantly different, whereas the α-diversities were comparable. The only significantly enriched bacterial genus associated with a history of EST was Pyramidobacter, while eight other genera were significantly decreased. For patients with AT, seven of these genera maintained their association with EST, including Pyramidobacter. However, after AT, the difference in β-diversities was diminished. EST induced a marked shift in the biliary microbial composition. A cluster of biliary bacteria was associated with a history of EST, and Pyramidobacter was specific to EST.
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Affiliation(s)
- Hongzhang Shen
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Juanjuan Zhu
- School of Life Science and Technology, China Pharmaceutical University, Nanjing, China
| | - Fuqiang Ye
- Department of Disease Control and Prevention, Center for Disease Control and Prevention of Eastern Theater Command, Nanjing, China
| | - Dongchao Xu
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liangliang Fang
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Jianfeng Yang
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huijie Lv
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qifeng Lou
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hangbin Jin
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ming Ni
- Beijing Institute of Radiation Medicine, Beijing, China
| | - Xiaofeng Zhang
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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12
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Liu Q, Li T, Feng Z, Han W. Medium and long-term complications difference between laparoscopic transcystic common bile duct exploration versus endoscopic sphincterotomy against choledocholithiasis: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24104. [PMID: 33546017 PMCID: PMC7837953 DOI: 10.1097/md.0000000000024104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/09/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Common bile duct stone (CBDS) is typically manifested with abdominal pain, chills, fever, and jaundice. Laparoscopic transcystic common bile duct exploration (LTCBDE) and endoscopic sphincterotomy (EST) are currently the main minimally invasive methods for the treatment of CBDS. However, there are few studies about the differences of medium and long-term complication after EST or LTCBDE. Therefore, we will conduct a meta-analysis and systematic review to systematically evaluate the difference of medium and long-term complications between EST and LTCBDE against CBDS. METHODS Randomized controlled trials of EST or LTCBDE against CBDS will be searched in several English and Chinese databases with the following vocabularies: "laparoscopic transcystic common bile duct exploration," "endoscopic sphincterotomy," "choledocholithiasis," "common bile duct stone" until December, 2020. Two reviewers will independently conduct the literature extraction, risk of bias assessment, and statistical analysis. RESULTS AND CONCLUSIONS The study will help to systematically evaluate the difference of medium and long-term complication between EST and LTCBDE against CBDS. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/5U7SA.
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Affiliation(s)
- Quanxin Liu
- Beijing Luhe Hospital, Capital Medical University, Tongzhou, Beijing
| | - Tao Li
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei province, China
| | - Zhangdong Feng
- Beijing Luhe Hospital, Capital Medical University, Tongzhou, Beijing
| | - Wei Han
- Beijing Luhe Hospital, Capital Medical University, Tongzhou, Beijing
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13
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Wu Y, Xu CJ, Xu SF. Advances in Risk Factors for Recurrence of Common Bile Duct Stones. Int J Med Sci 2021; 18:1067-1074. [PMID: 33456365 PMCID: PMC7807200 DOI: 10.7150/ijms.52974] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/22/2020] [Indexed: 12/13/2022] Open
Abstract
Choledocholithiasis is a chronic common disease. The incidence of cholelithiasis is 5%-15%, of which 5%-30% are combined with Choledocholithiasis. Although endoscopic cholangiopancreatography (ERCP) + endoscopic sphincterotomy (EST) is the most common treatment procedure, which clearance rate is up to 95%, the incidence of recurrent choledocholithiasis was 4%-25%. The risk factors of recurrence after choledocholithiasis clearance are the focuses of current researches, which are caused by multiple factors. We first systematically summarize the risk factors of common bile duct stones (CBDS) recurrence into five aspects: first-episode stone related factors, congenital factors, biological factors, behavioral intervention factors, and the numbers of stone recurrence.
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Affiliation(s)
- Yao Wu
- Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211100, China
| | - Chen Jing Xu
- Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211100, China
| | - Shun Fu Xu
- Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211100, China.,Jiangsu Province Hospital, Nanjing Medical University, Nanjing, 210029, China
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14
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Zhu J, Du P, He J, Tong F, Xiao W, Li Y. Laparoscopic common bile duct exploration for patients with a history of prior biliary surgery: a comparative study with an open approach. ANZ J Surg 2020; 91:E98-E103. [PMID: 33369850 DOI: 10.1111/ans.16529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Laparoscopic common bile duct exploration (LCBDE) is increasingly being used to treat choledocholithiasis. However, few studies have examined the treatment of recurrent common bile duct stones (CBDS) in patients with a history of prior biliary surgery. The current research aimed to compare the outcomes of laparoscopic versus open common bile duct exploration in patients with a history of prior biliary surgery. METHODS Between March 2010 and August 2019, 162 patients with recurrent CBDS after prior biliary surgery who underwent surgical management in our institution were enrolled in this study. The demographic, intraoperative and postoperative data were retrospectively analysed. RESULTS Among these 162 patients, 72 underwent laparoscopic approach (LCBDE group), and 90 underwent open surgery (open common bile duct exploration group). The LCBDE group was associated with significantly lower overall complication rate, incision infection rate and blood loss compared to open common bile duct exploration group (all P < 0.05). Moreover, the laparoscopic approach significantly reduced the length of postoperative hospital stay (P < 0.05). However, the operative time, stone clearance rate, and stone recurrence rate were not significantly different between the two groups (P > 0.05). The conversion rate of the laparoscopic approach was 6.9%. CONCLUSIONS LCBDE is superior to open procedure in terms of blood loss, hospital stay, overall complication and incision infection in patients with a history of prior biliary surgery, and it should be considered as a safe and effective treatment if it is performed by an experienced surgeon.
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Affiliation(s)
- Jisheng Zhu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Peng Du
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianpeng He
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fengxiong Tong
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Weidong Xiao
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
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15
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Park SY, Hong TH, Lee SK, Park IY, Kim TH, Kim SG. Recurrence of common bile duct stones following laparoscopic common bile duct exploration: a multicenter study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2019; 26:578-582. [DOI: 10.1002/jhbp.675] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Sun Young Park
- Department of General Surgery Yeouido St. Mary’s HospitalCollege of MedicineThe Catholic University of Korea 63‐ro 10, Yeongdeungpo‐gu Seoul07345Korea
| | - Tae Ho Hong
- Department of Hepatobiliary and Pancreas Surgery Seoul St. Mary’s HospitalCollege of MedicineThe Catholic University of Korea Seoul Korea
| | - Sang Kuon Lee
- Department of General Surgery Daejeon St. Mary’s Hospital College of Medicine The Catholic University of Korea Daejeon Korea
| | - Il Young Park
- Department of General Surgery Bucheon St. Mary’s HospitalCollege of MedicineThe Catholic University of Korea Bucheon Korea
| | - Tae Hyeon Kim
- Division of Gastroenterology Department of Internal Medicine Wonkwang University Medical School and Hospital Iksan Korea
| | - Sung Geun Kim
- Department of General Surgery Yeouido St. Mary’s HospitalCollege of MedicineThe Catholic University of Korea 63‐ro 10, Yeongdeungpo‐gu Seoul07345Korea
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