Risk factors for recurrence of common bile duct stones after surgical treatment and effect of ursodeoxycholic acid intervention

doi:10.4240/wjgs.v16.i1.103

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Jan 27, 2024 (publication date) through Feb 4, 2025

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastrointest Surg. Jan 27, 2024; 16(1): 103-112
Published online Jan 27, 2024. doi: 10.4240/wjgs.v16.i1.103

Table 1 Patient characteristics

Variable		Total (n = 100)	Control (n = 47)	UDCA (n = 53)
Age (yr), median (P₂₅, P₇₅)		53.00 (48, 60)	51 (47, 60)	54 (48.5, 60)
Gender, n (%)	Male	44 (44)	21 (44.68)	23 (23.40)
	Female	56 (56)	26 (55.32)	30 (56.60)
Jaundice, n (%)	Yes	27 (27)	12 (25.53)	15 (28.30)
	No	73 (73)	35 (74.47)	38 (71.70)
Hypertension, n (%)	Yes	25 (25)	12 (25.53)	14 (26.42)
	No	75 (75)	35 (74.47)	39 (73.58)
Diabetes, n (%)	Yes	32 (32)	14 (29.79)	18 (33.96)
	No	68 (68)	33 (70.21)	35 (66.04)
History of biliary tract surgery, n (%)	Yes	14 (14)	6 (12.77)	8 (15.09)
	No	86 (86)	41 (87.23)	45 (84.91)
Parapillary diverticulum, n (%)	Yes	36 (36)	23 (48.94)	13 (24.53)
	No	64 (64)	24 (51.06)	40 (75.47)
No. of stones, n (%)	≤ 3	49 (49)	25 (53.19)	24 (45.28)
	> 3	51 (51)	22 (46.81)	29 (54.72)
Bile culture positive, n (%)		37 (37)	20 (42.55)	17 (32.08)
Common bile duct diameter (mm), median (P₂₅, P₇₅)		14.00 (13.00, 16.00)	15.0 (13.0, 16.0)	14.0 (12.0, 16.0)
Maximum stone diameter (mm), median (P₂₅, P₇₅)		13.00 (12.00, 15.00)	13.0 (12.0, 15.0)	13.0 (11.5, 14.5)
ERCP time (min), median (P₂₅, P₇₅)		64.00 (61.00, 68.00)	63 (61, 67)	64 (61, 71)
WBC (10⁹/L, mean ± SD)		6.60 ± 0.96	6.24 ± 1.24	6.60 ± 0.97
PCT (ng/mL), median (P₂₅, P₇₅)		0.18 (0.12, 0.27)	0.17 (0.12, 0.25)	0.18 (0.13, 0.28)

UDCA: Ursodeoxycholic acid; ERCP: Endoscopic retro-grade cholangiopancreatography; WBC: White blood cell; PCT: Procalcitonin.

Table 2 Comparison of clinical efficacy between control and ursodeoxycholic acid groups

Group	Efficacious	Effective	Ineffective	χ² value	P value
Control, n (%)	16 (34.04)	21 (44.68)	10 (21.28)	3.990	0.048
UDCA, n (%)	22 (41.51)	27 (50.94)	4 (7.55)

UDCA: Ursodeoxycholic acid.

Table 3 Comparison of liver function indexes between control and ursodeoxycholic acid groups

Group	n	TBiL (μmon/L, mean ± SD)		DBiL (μmon/L, mean ± SD)		GGT (U/L, mean ± SD)
Group	n	Pre-treatment	Post-treatment	Pre-treatment	Post-treatment	Pre-treatment	Post-treatment
Control	47	96.65 ± 11.24	77.31 ± 8.52	63.74 ± 7.45	45.39 ± 5.69	328.65 ± 20.45	189.63 ± 16.87
UDCA	53	98.63 ± 11.42	55.39 ± 6.53	63.36 ± 7.96	32.10 ± 4.62	330.25 ± 20.64	142.32 ± 14.21
t value		0.872	-14.532	-0.251	-12.896	0.388	-15.217
P value		0.385	< 0.001	0.803	< 0.001	0.699	< 0.001
		ALT (U/L, mean ± SD)		ALP (U/L, mean ± SD)		AST (U/L, mean ± SD)
		Pre-treatment	Post-treatment	Pre-treatment	Post-treatment	Pre-treatment	Post-treatment
Control	47	274.63 ± 25.41	149.36 ± 15.36	256.66 ± 24.12	171.33 ± 22.09	201.32 ± 16.35	121.35 ± 11.57
UDCA	53	268.54 ± 21.23	112.52 ± 14.25	262.36 ± 25.78	122.61 ± 16.00	201.11 ± 15.47	96.98 ± 10.44
t value		-1.306	-12.440	1.139	-12.733	-0.066	-11.072
P value		0.195	< 0.001	0.257	< 0.001	0.947	< 0.001

TBiL: Total bilirubin; DBiL: Direct bilirubin; GGT: Gamma-glutamyl transferase; ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; AST: Aspartate aminotransferase; UDCA: Ursodeoxycholic acid.

Table 4 Univariate analysis of recurrence of common bile duct stones after endoscopic retro-grade cholangiopancreatography

Variables		Non-recurrent group (n = 72)	Recurrent group (n = 28)	χ² value	P value
Age (yr, mean ± SD)		54.64 ± 6.62	51.43 ± 8.74	-1.983	0.050
Gender, n (%)	Male	31 (43.06)	13 (46.43)	0.093	0.760
	Female	41 (56.94)	15 (53.57)
Jaundice, n (%)	Yes	19 (26.39)	8 (28.57)	0.049	0.825
	No	53 (73.61)	20 (71.43)
Hypertension, n (%)	Yes	18 (25.00)	8 (28.57)	0.134	0.715
	No	54 (75.00)	20 (71.43)
Diabetes, n (%)	Yes	27 (37.50)	5 (17.86)	3.575	0.059
	No	45 (62.50)	23 (82.14)
History of biliary tract surgery, n (%)	Yes	12 (16.67)	2 (7.14)	1.519	0.218
	No	60 (83.33)	26 (92.86)
Parapillary diverticulum, n (%)	Yes	18 (25.00)	18 (64.29)	13.504	< 0.001
	No	54 (75.00)	10 (35.71)
No. of stones, n (%)	≤ 3	46 (63.89)	11 (39.29)	4.979	0.026
	> 3	26 (36.11)	17 (60.71)
Bile culture positive, n (%)		19 (26.39)	18 (64.29)	12.421	< 0.001
Postoperative treatment, n (%)	Control	26 (36.11)	21 (75.00)	12.240	< 0.001
	UDCA	46 (63.89)	7 (25.00)
Common bile duct diameter(mm), median (P₂₅, P₇₅)		14.00 (12.00, 15.00)	16.00 (14.00, 17.00)	-3.265	0.001
Maximum stone diameter(mm), median (P₂₅, P₇₅)		12.00 (11.25, 13.75)	15.00 (12.00, 16.00)	-3.599	< 0.001
ERCP time (min, mean ± SD)		63.93 ± 5.12	65.82 ± 5.33	1.640	0.140
WBC (× 10⁹/L, mean ± SD)		6.45 ± 1.05	6.38 ± 1.27	-0.290	0.772
PCT (ng/mL), median (P₂₅, P₇₅)		0.18 (0.12, 0.27)	0.18 (0.12, 0.28)	-0.088	0.930
TBiL (μmon/L, mean ± SD)		97.85 ± 10.95	97.32 ± 12.43	-0.211	0.833
DBiL (μmon/L, mean ± SD)		64.13 ± 7.64	62.02 ± 7.76	-1.234	0.220
GGT (U/L, mean ± SD)		330.90 ± 19.82	325.88 ± 21.99	-1.102	0.273
ALT (U/L, mean ± SD)		272.31 ± 22.87	269.09 ± 24.88	-0.617	0.538
ALP (U/L, mean ± SD)		259.81 ± 25.79	259.36 ± 23.50	-0.079	0.937
AST (U/L, mean ± SD)		201.12 ± 16.02	201.44 ± 15.55	0.089	0.929

ERCP: Endoscopic retro-grade cholangiopancreatography; UDCA: Ursodeoxycholic acid; WBC: White blood cell; PCT: Procalcitonin; TBiL: Total bilirubin; DBiL: Direct bilirubin; GGT: Gamma-glutamyl transferase; ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; AST: Aspartate aminotransferase.

Table 5 Variable assignment description

Variables	Assignment
Parapillary diverticulum	0 = no, 1 = yes
No. of stones	0 = ≤ 2, 1 = > 3
Bile culture positive	0 = no, 1 = yes
Postoperative treatment	0 = UDCA, 1 = control
Common bile duct diameter	Original value
Maximum stone diameter	Original value

UDCA: Ursodeoxycholic acid.

Table 6 Multivariate logistic regression analysis comparing the non-recurrent group vs recurrent groups

Variables	β	SE	Wald χ²	P value	OR (95%CI)
Parapillary diverticulum	1.792	0.646	7.692	0.006	6.003 (1.692-21.303)
No. of stones > 3	1.443	0.654	4.863	0.027	4.233 (1.174-15.263)
Bile culture positive	2.029	0.663	9.357	0.002	47.606 (2.073-27.910)
Postoperative UDCA	-1.287	0.628	4.199	0.040	0.072 (0.080-0.094)
Maximum stone diameter	0.527	0.265	3.957	0.047	1.694 (1.008-2.847)
Constant	-8.895	2.360	14.211	< 0.001	-

UDCA: Ursodeoxycholic acid.

Citation: Yuan WH, Zhang Z, Pan Q, Mao BN, Yuan T. Risk factors for recurrence of common bile duct stones after surgical treatment and effect of ursodeoxycholic acid intervention. World J Gastrointest Surg 2024; 16(1): 103-112
URL: https://www.wjgnet.com/1948-9366/full/v16/i1/103.htm
DOI: https://dx.doi.org/10.4240/wjgs.v16.i1.103