New common bile duct morphological subtypes: Risk predictors of common bile duct stone recurrence

Table 1 Patient characteristics

Characteristics	n (%)
Patients	502
Recurrence	43 (8.6)
Multiple recurrences	9 (1.8)
Male	287 (57.2)
Age (mean ± SD, yr)	65.2 ± 15.6
Age 70 yr	201 (40.0)
PAD	243 (48.4)
CBD diameter (mean ± SD, cm)	1.3 ± 0.7
CBD diameter 1.5 cm	160 (31.9)
Largest CBD stone diameter 1.5 cm	83 (16.3)
CBD stone number 2	189 (37.6)
Muddy stones	131 (26.1)
Initial ampullary intervention
EST	141 (28.1)
EPBD/EPLBD	31 (6.2)
ESBD	315 (62.7)
CBD morphology
Straight type	289 (57.6)
S type	45 (9.0)
Polyline type	168 (33.5)
Cholecystectomy	26 (5.2)
Gastrectomy	9 (1.8)
Procedure time (mean ± SD, min)	20.0 ± 13.7

PAD: Periampullary diverticulum; CBD: Common bile duct; EST: Endoscopic biliary sphincterotomy; EPBD: Endoscopic papillary balloon dilation; EPLBD: Endoscopic papillary large balloon dilation; ESBD: Endoscopic biliary sphincterotomy with balloon dilation.

Table 2 Patient characteristics of patients with and without common bile duct stone recurrence, n (%)

Characteristics	Recurrence (n = 43)	Nonrecurrence (n = 459)	P value
Sex (male/female)	23/20	264/195	0.61
Age ≥ 70 yr	25 (58.1)	176 (38.3)	0.01
PAD	23 (53.5)	220 (47.9)	0.49
CBD diameter (mean ± SD, cm)	1.5 ± 0.5	1.3 ± 0.7	0.06
CBD diameter ≥ 1.5 cm	23 (53.5)	137 (29.8)	< 0.01
Largest CBD stone diameter ≥ 1.5 cm	11 (25.6)	71 (15.5)	0.09
CBD stone number ≥ 2	15 (34.9)	174 (37.9)	0.70
Muddy stones	12 (27.9)	119 (25.9)	0.78
Initial ampullary intervention
EST	13 (30.2)	128 (27.9)	0.74
EPBD/EPLBD	9 (20.9)	22 (4.8)	< 0.01
ESBD	17 (39.5)	298 (64.9)	< 0.01
CBD morphology			< 0.01
Straight type	14 (32.6)	275 (59.9)
S type	11 (25.6)	34 (7.4)
Polyline type	18 (41.9)	150 (32.7)
Cholecystectomy	5 (11.6)	21 (4.6)	0.06
Procedure time (mean ± SD, min)	19.3 ± 14.2	20.1 ± 13.6	0.71
Gastrectomy	3 (7.0)	6 (1.3)	0.03

PAD: Periampullary diverticulum; CBD: Common bile duct; EST: Endoscopic biliary sphincterotomy; EPBD: Endoscopic papillary balloon dilation; EPLBD: Endoscopic papillary large balloon dilation; ESBD: Endoscopic biliary sphincterotomy with balloon dilation.

Table 3 Patient characteristics of patients with different common bile duct morphologies, n (%)

Characteristics	Straight type (n = 289)	S type (n = 45)	Polyline type (n = 168)	P value
Sex (male/female)	166/123	30/15	91/77	0.32
Age ≥ 70 yr	104 (36.0)	20 (44.4)	77 (45.8)	0.10
PAD	136 (47.1)	20 (44.4)	87 (51.8)	0.53
CBD diameter (mean ± SD, cm)	1.3 ± 0.4	1.5 ± 0.5	1.4 ± 0.9	0.14
CBD diameter ≥ 1.5 cm	96 (33.2)	22 (48.9)	42 (25.0)	0.01
Largest CBD stone diameter ≥ 1.5 cm	42 (14.5)	8 (17.8)	32 (19.0)	0.44
CBD stone number ≥ 2	105 (36.3)	17 (37.8)	67 (39.9)	0.75
Muddy stones	78 (27.0)	11 (24.4)	42 (25.0)	0.87
Initial ampullary intervention
EST	84 (29.1)	11 (24.4)	46 (27.4)	0.79
EPBD/EPLBD	18 (6.2)	3 (6.7)	10 (6.0)	0.98
ESBD	180 (62.3)	30 (66.7)	105 (62.5)	0.85
Cholecystectomy	19 (6.6)	2 (4.4)	5 (3.0)	0.24
Procedure time (mean ± SD, min)	19.8 ± 11.7	19.7 ± 13.1	20.6 ± 16.7	0.81
Gastrectomy	5 (1.7)	0 (0.0)	4 (2.4)	0.38

PAD: Periampullary diverticulum; CBD: Common bile duct; EST: Endoscopic biliary sphincterotomy; EPBD: Endoscopic papillary balloon dilation; EPLBD: Endoscopic papillary large balloon dilation; ESBD: Endoscopic biliary sphincterotomy with balloon dilation.

Table 4 Characteristics of patients with single recurrence and multiple recurrences, n (%)

Characteristics	Single recurrence (n = 34)	Multiple recurrences (n = 9)	P value
Sex (male/female)	19/15	4/5	0.71
Age (mean ± SD, yr)	71.3 ± 13.7	68.6 ± 12.2	0.59
Age ≥ 70 yr	21 (61.8)	4 (44.4)	0.46
PAD	21 (61.8)	2 (22.2)	0.06
CBD diameter (mean ± SD, cm)	1.5 ± 0.5	1.6 ± 0.6	0.43
CBD diameter ≥ 1.5 cm	18 (52.9)	5 (55.6)	1.00
Largest CBD stone diameter ≥ 1.5 cm	10 (29.4)	1 (11.1)	0.41
CBD stone number ≥ 2	12 (35.3)	3 (33.3)	1.00
Muddy stones	10 (29.4)	2 (22.2)	1.00
Initial ampullary intervention
EST	10 (29.4)	3 (33.3)	1.00
EPBD/EPLBD	6 (17.6)	3 (33.3)	0.37
ESBD	16 (47.1)	1 (11.1)	0.07
CBD morphology			0.22
straight type	12 (35.3)	2 (22.2)
S type	10 (29.4)	1 (11.1)
polyline type	12 (35.3)	6 (66.7)
Cholecystectomy	5 (14.7)	0 (0.0)	0.57
Gastrectomy	3 (8.8)	0 (0.0)	1.00
Procedure time (mean ± SD, min)	19.9 ± 15.7	17.0 ± 6.3	0.60

PAD: Periampullary diverticulum; CBD: Common bile duct; EST: Endoscopic biliary sphincterotomy; EPBD: Endoscopic papillary balloon dilation; EPLBD: Endoscopic papillary large balloon dilation; ESBD: Endoscopic biliary sphincterotomy with balloon dilation.

Table 5 Risk factors for common bile duct stone recurrence

Factor	B	OR (95%CI)	P value	B	OR (95%CI)	P value
Age ≥ 70yr	0.69	1.99 (0.99-4.00)	0.06
CBD diameter ≥ 1.5 cm	0.79	2.20 (1.08-4.46)	0.03
EPBD/EPLBD	0.92	2.51 (0.89-7.06)	0.08
ESBD	-1.04	0.35 (0.17-0.75)	< 0.01
Gastrectomy	1.46	4.29 (0.84-21.83)	0.08
CBD morphology			< 0.01			< 0.01
Straight type		Reference		-0.90	0.41 (0.19-0.88)	0.02
S type	1.89	6.61 (2.61-16.77)	< 0.01	0.99	2.70 (1.08-6.73)	0.03
Polyline type	0.90	2.45 (1.14-5.26)	0.02		Reference

CBD: Common bile duct; EPBD: Endoscopic papillary balloon dilation; EPLBD: Endoscopic papillary large balloon dilation; ESBD: Endoscopic biliary sphincterotomy with balloon dilation; OR: Odds ratio.