Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2022; 14(3): 236-246
Published online Mar 27, 2022. doi: 10.4240/wjgs.v14.i3.236
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
Xu Ji, Zhuo Yang, Shu-Ren Ma, Wen Jia, Qian Zhao, Lu Xu, Ying Kan, Yang Cao, Yao Wang, Bao-Jun Fan, Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
Xu Ji, Postgraduate College, Dalian Medical University, Dalian 116044, Liaoning Province, China
Author contributions: Ji X and Yang Z contributed to drafting the final manuscript; Ji X, Ma SR, Jia W, Zhao Q, Xu L, Ka Y, Cao Y, Wang Y, Fan BJ, Yang Z contributed to study design, data collection, statistical analysis, and reading and approving the final manuscript.
Supported by Key Research and Development Program of Liaoning Province, China, No. 2019JH2/10300026.
Institutional review board statement: The study was reviewed and approved by the General Hospital of Northern Theater Command Institutional Review Board [No. Y(2021)067].
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors disclose no conflicts.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhuo Yang, MD, Chief Doctor, Department of Digestive Endoscopy, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang 110840, Liaoning Province, China. yangzhuocy@163.com
Received: November 1, 2021
Peer-review started: November 1, 2021
First decision: December 4, 2021
Revised: December 12, 2021
Accepted: March 6, 2022
Article in press: March 6, 2022
Published online: March 27, 2022
Processing time: 144 Days and 2.6 Hours
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: Endoscopic retrograde cholangiopancreatography; Common bile duct stones; Recurrence; Common bile duct morphology; Risk factors

Core Tip: 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 reported. We demonstrate that CBD morphology was an independent risk factor for CBD stone recurrence in patients. Furthermore, the S type and polyline type were associated with an increased risk of recurrent CBD stones. This information represents a new perspective by defining the shape of the common bile duct on cholangiograms, which could redefine the risk factors and models of recurrence and predict periodic follow-up.