Incidence and risk factors for postoperative common bile duct stones in patients undergoing endoscopic extraction and subsequent cholecystectomy,Gastrointestinal Endoscopy

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Incidence and risk factors for postoperative common bile duct stones in patients undergoing endoscopic extraction and subsequent cholecystectomy
Gastrointestinal Endoscopy ( IF 7.7 ) Pub Date : 2020-06-26 , DOI: 10.1016/j.gie.2020.06.060
Jung Wan Choe ₁ , Seung Young Kim ₁ , Dong-Won Lee ₁ , Jong Jin Hyun ₁ , Ke Ryun Ahn ₁ , Ik Yoon ₁ , Sung Woo Jung ₁ , Young Kul Jung ₁ , Ja Seol Koo ₁ , Hyung Joon Yim ₁ , Sang Woo Lee ₁

Affiliation

Background and Aims

In patients who undergo cholecystectomy after endoscopic common bile duct (CBD) stone extraction, CBD stones found postoperatively could be problematic. This study aimed to investigate the incidence and risk factors of postoperative CBD stones after cholecystectomy.

Methods

A total of 278 patients (mean age, 59.2 years; 71 men [51.1%]) who underwent endoscopic removal of CBD stones followed by cholecystectomy from January 2013 to December 2017 were included. An endoscopic nasobiliary drainage (ENBD) tube was placed immediately after endoscopic clearance of the CBD stones in all patients until cholecystectomy. An ENBD tubogram was obtained in all patients to determine the presence of postoperative CBD stones.

Results

Postoperative CBD stones were detected in 20.1% (56/278). An ENBD tubogram was obtained after an average of 2.42 days postoperatively. Based on univariate analysis, the statistically significant risk factors for postoperative CBD stone were CBD stones >2, CBD stone size >10 mm, cholesterol stone, maximum diameter of CBD >15 mm, treatment with endoscopic sphincterotomy alone, and use of endoscopic mechanical lithotripsy (EML). In multivariate analysis, cholesterol stone, CBD stones >2, CBD stone size >10 mm, and EML were related to postoperative CBD stones after cholecystectomy.

Conclusions

Based on the relatively high rate of postoperative CBD stones after cholecystectomy, careful follow-up should be considered in patients with high-risk factors to detect CBD stones early.

中文翻译：

内窥镜摘除及随后的胆囊切除术患者术后胆总管结石的发生率和危险因素

背景和目标

对于内镜下胆总管结石摘除术进行胆囊切除术的患者，术后发现的CBD结石可能是有问题的。本研究旨在探讨胆囊切除术后CBD结石的发生率和危险因素。

方法

纳入了2013年1月至2017年12月行内窥镜下切除CBD结石并进行胆囊切除术的278例患者（平均年龄59.2岁； 71例男性[51.1％]）。在内窥镜清除所有患者的CBD结石后立即放置内窥镜鼻胆管（ENBD）管，直到进行胆囊切除术为止。在所有患者中均获得ENBD图像，以确定术后CBD结石的存在。

结果

术后CBD结石检出率为20.1％（56/278）。术后平均2.42天后获得ENBD图像。基于单因素分析，术后CBD结石的统计学显着危险因素为CBD结石> 2，CBD结石尺寸> 10 mm，胆固醇结石，CBD的最大直径> 15 mm，仅经内镜括约肌切开术和使用内镜机械碎石术（EML）。在多变量分析中，胆囊切除术后胆固醇结石，CBD结石> 2，CBD结石尺寸> 10 mm和EML与术后CBD结石有关。