Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2024; 16(1): 103-112
Published online Jan 27, 2024. doi: 10.4240/wjgs.v16.i1.103
Risk factors for recurrence of common bile duct stones after surgical treatment and effect of ursodeoxycholic acid intervention
Wei-Hong Yuan, Zheng Zhang, Qi Pan, Bo-Neng Mao, Tao Yuan
Wei-Hong Yuan, Zheng Zhang, Qi Pan, Bo-Neng Mao, Tao Yuan, Department of Gastroenterology, Yixing People’s Hospital, Yixing 214200, Jiangsu Province, China
Author contributions: Yuan WH designed and wrote the paper; Yuan T designed the research and supervised the report; Zhang Z, Pan Q and Mao BN designed the research and contributed to the analysis; all authors have approved the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Yixing People’s Hospital.
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 declare no conflict of interest.
Data sharing statement: The clinical data used in this study can be obtained from the corresponding author upon request.
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: Tao Yuan, MM, Attending Doctor, Department of Gastroenterology, Yixing People’s Hospital, No. 1588 Xincheng Road, Yixing 214200, Jiangsu Province, China. staff1848@yxph.com
Received: November 3, 2023
Peer-review started: November 3, 2023
First decision: November 16, 2023
Revised: November 29, 2023
Accepted: January 2, 2024
Article in press: January 2, 2024
Published online: January 27, 2024
Abstract
BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) is an accurate diagnostic method for choledocholithiasis and treatment option for stone removal. Additionally, ursodeoxycholic acid (UDCA) can dissolve cholesterol stones and prevent their development and reappearance by lowering the cholesterol concentration in bile. Despite these treatment options, there are still patients who experience stone recurrence.

AIM

To analyze the risk factors for choledocholithiasis recurrence after ERCP retrograde cholangiopancreatography and the effect of UDCA intervention.

METHODS

The clinical data of 100 patients with choledochal stones who were hospitalized at the Yixing People’s Hospital and underwent ERCP for successful stone extraction between June 2020 and December 2022 were retrospectively collected. According to the post-ERCP treatment plan, 100 patients were classified into UDCA (n = 47) and control (n = 53) groups. We aimed to assess the clinical efficacy and rate of relapse in the two patient populations. We then collected information (basic demographic data, clinical characteristics, and serum biochemical indicators) and determined the factors contributing to relapse using logistic regression analysis. Our secondary goal was to determine the effects of UDCA on liver function after ERCP.

RESULTS

Compared to the control group, the UDCA group demonstrated a higher clinical effectiveness rate of 92.45% vs 78.72% (P < 0.05). No significant differences were observed in liver function indices, including total bilirubin, direct bilirubin, gamma-glutamyl transpeptidase, alanine aminotransferase, alkaline phosphatase, and aspartate aminotransferase, between the two groups before treatment. After treatment, all liver function indices were significantly reduced. Comparing the control vs UDCA groups, the UDCA group exhibited significantly lower levels of all indices (55.39 ± 6.53 vs 77.31 ± 8.52, 32.10 ± 4.62 vs 45.39 ± 5.69, 142.32 ± 14.21 vs 189.63 ± 16.87, 112.52 ± 14.25 vs 149.36 ± 15.36, 122.61 ± 16.00 vs 171.33 ± 22.09, 96.98 ± 10.44 vs 121.35 ± 11.57, respectively, all P < 0.05). The stone recurrence rate was lower in the UDCA group (13.21%) in contrast with the control group (44.68%). Periampullary diverticula (OR: 6.00, 95%CI: 1.69-21.30), maximum stone diameter (OR: 1.69, 95%CI: 1.01-2.85), stone quantity >3 (OR: 4.23, 95%CI: 1.17-15.26), and positive bile culture (OR: 7.61, 95%CI: 2.07-27.91) were independent factors that influenced the relapse of common bile duct stones after ERCP (P < 0.05). Furthermore, postoperative UDCA was identified as a preventive factor (OR: 0.07; 95%CI: 0.08-0.09).

CONCLUSION

The intervention effect of UDCA after ERCP for common bile duct stones is adequate, providing new research directions and references for the prevention and treatment of stone recurrence.

Keywords: Endoscopic retrograde cholangiopancreatography, Recurrence, Ursodeoxycholic acid, Common bile duct stones, Clinical effective rate, Risk factors

Core Tip: Choledocholithiasis is a common biliary disorder that can be treated by endoscopic retrograde cholangiopancreatography. However, postoperative recurrence of bile duct stones is a common complication. Ursodeoxycholic acid (UDCA) is used to treat biliary disorders mainly by lowering cholesterol saturation, facilitating bile flow, and reducing inflammation. Through these actions, UDCA improves symptoms, prevents and treats gallstone formation, and promotes biliary health in patients with biliary tract disorders.