Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2019; 25(4): 485-497
Published online Jan 28, 2019. doi: 10.3748/wjg.v25.i4.485
Outcomes of endoscopic sphincterotomy vs open choledochotomy for common bile duct stones
Xiao-Dong Zhou, Qiao-Feng Chen, Yuan-Yuan Zhang, Ming-Ju Yu, Chang Zhong, Zhi-Jian Liu, Guo-Hua Li, Xiao-Jiang Zhou, Jun-Bo Hong, You-Xiang Chen
Xiao-Dong Zhou, Qiao-Feng Chen, Yuan-Yuan Zhang, Ming-Ju Yu, Chang Zhong, Zhi-Jian Liu, Guo-Hua Li, Xiao-Jiang Zhou, Jun-Bo Hong, You-Xiang Chen, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Zhou XD and Chen QF contributed equally to this work; Chen QF and Zhang YY designed the study and drafted the manuscript; Yu MJ collected and analyzed the data; Zhong C collected the data; Liu ZJ, Li GH, Hong JB, and Zhou XJ revised the manuscript for important intellectual content; Zhou XD and Chen YX made substantial contributions to conception, design, and coordination of the study and gave final approval of the version to be published. All authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the institutional review board of The First Affiliated Hospital of Nanchang University.
Informed consent statement: All involved persons provided written or verbal informed consent prior to study inclusion.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: You-Xiang Chen, MD, PhD, Chief Doctor, Professor, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng Street, Nanchang 330006, Jiangxi Province, China.
Telephone: +86-13879169980 Fax: +86-791-88692505
Received: November 17, 2018
Peer-review started: November 19, 2018
First decision: November 29, 2018
Revised: December 13, 2018
Accepted: January 9, 2019
Article in press: January 10, 2019
Published online: January 28, 2019
Research background

Endoscopic sphincterotomy (EST) and open choledochotomy (OCT) are two common therapeutic modalities for the management of common bile duct stones (CBDS). Over time, EST as a minimally invasive approach has become safe, efficient, and cost-effective. However, it remains unclear whether there are any differences in outcomes between these two approaches for the treatment of CBDS.

Research motivation

Some clinical practitioners argued that EST may be complicated by post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and are associated with a higher recurrence of CBDS than OCT. Additionally, the risk factors associated with recurrence have not yet been established firmly. We wanted to investigate these issues to help guide clinicians in efforts to manage CBDS better.

Research objectives

The retrospective study aimed to compare the clinical outcomes of EST vs OCT for the management of CBDS and to identify the risk factors associated with stone recurrence.

Research methods

This study included 302 patients with CBDS who met the criteria. The short- and long-term clinical outcomes were compared between the EST and OCT groups. Propensity score matching was performed to adjust for the effects of confounding factors. Recurrence of CBDS was calculated by the Kaplan-Meier method with the use of the log-rank test. Risk factors for recurrence were identified using a logistic regression model.

Research results

EST was associated with shorter time to relieving the biliary obstruction, anesthetic duration, procedure time, and hospital stay than OCT. The overall incidence of complications and mortality did not differ significantly between the two groups. There was no significant difference in recurrence rate between the EST (18/88, 20.5%) and OCT (15/88, 17.0%) groups. The area under the receiver operating characteristic (ROC) curve for the logistic regression model incorporating CBD diameter ≥ 15 mm, multiple CBDS, and distal CBD angle ≤ 145° was 0.81 (95%CI: 0.76-0.87).

Research conclusions

EST shows better results in short-term outcomes, including shorter time to relief of biliary obstruction, anesthetic duration, procedure time, and hospital stay, and was not associated with an increased recurrence rate or mortality compared with OCT in the management of CBDS. CBD dilatation, multiple CBDS, and distal CBD angle ≤ 145° are independent risk factors for CBDS recurrence, and these factors may help screen out high-risk patients who require follow-up more frequently.

Research perspectives

EST can be performed safely without posing a higher risk of subsequent recurrent CBDS or overall mortality than OCT. Additional randomized controlled trials are needed to further validate these findings.