Retrospective Study
Copyright ©The Author(s) 2017.
World J Gastrointest Endosc. Jan 16, 2017; 9(1): 26-33
Published online Jan 16, 2017. doi: 10.4253/wjge.v9.i1.26
Table 5 Risk factors for recurrence of choledocholithiasis proposed in the literature
Proposed risk factorRef. Comment section
DBR[19-21]DBR
Pneumobilia[19]Indicative of DBR
Acute distal CBD angulation[19]Promotes bile stasis
CBD dilation[19]Promotes bile stasis
Periampullary diverticulum[19]Promotes bile stasis
Prior EST[22,23]Promotes DBR
Intact gallbladder with stones in situ[22](Secondary) stone CBD migration
Billiary stricture[22]Promotes bile stasis
Papillary stenosis[22]Promotes bile stasis
ML[22]Small residual microlithiasis acts as nidi for stone formation
Stone size[24]Size of the largest stone
Cirrhosis[22]Delayed biliary emptying/bile stasis
Delayed biliary emptying[22]Promotes bile stasis
Bacterial infection/colonization of the CBD. Bacterial count[25,26]Promotes chronic infection, and inflammation, promotes stone formating
Impaired biliary flow[25]Scintigraphic study
Cholecystectomy (without stones)[27]Impede flushing of nidus/residual stones
Post-procedural sphincter function impaired[6,27]EST vs EPBD/EPLBD vs EPSBD, promote DBR
Number of sessions to clear duct at first presentation[6]# of ERCPs required to achieve a patent CBD
Age[6]Old age
Previous cholecystectomy (open or lap)[6]
Serum lvls of chol[24]Lithogenic properties
EST size[24]Minimal size is protective
Inflammation CBD[24]
Parasites of the CBD[24]Parasitic infection
Foreign bodies in the CBD[24]
Concurrent cholecystolithiasis and cholelithiasis[28]
Post stone removal CBD diameter[21]At 72 h after stones removal, cholangiogram via nasobiliary tube
EPLBD > 10 mm[29]Disruption of SO, DBR
Variations of the ABCB4, ABCB11 genes[30]Affect composition of bile. Associated with cholestasis, cholelithiasis and formation of primary intrahepatic stones
Excessive dilation of the CBD[31]Recurrence rate was 40% when maximum CBD diameter was more than 20 mm, whereas recurrence rate was 18% when maximum CBD diameter was 20 mm or less