Published online Sep 16, 2021. doi: 10.12998/wjcc.v9.i26.7671
Peer-review started: April 29, 2021
First decision: May 26, 2021
Revised: June 20, 2021
Accepted: July 29, 2021
Article in press: July 29, 2021
Published online: September 16, 2021
Processing time: 134 Days and 6.5 Hours
Endoscopic retrograde cholangiopancreatography (ERCP) is the first choice for removing common bile duct (CBD) stones in Billroth II anatomy patients. The risk factors for CBD stone recurrence after ERCP have been discussed for many years. However, CBD morphology had never been noticed as a potential risk factor.
Our study introduced the new concept of CBD morphology on the cholangiogram and classified it into straight type, S type, and polyline type.
The objective of this study was to evaluate CBD morphology and other predictors affecting CBD stone recurrence in Billroth II gastrectomy patients.
We performed a retrospective case-control analysis of CBD stones patients with a history of Billroth II gastrectomy, and there were 138 patients who underwent therapeutic ERCP at our center from January 2011 to October 2020. We examined the possible predictors of CBD stone recurrence by univariate analysis and multivariate logistic regression analysis.
CBD morphology (P < 0.01) and CBD diameter ≥ 1.5 cm (odds ratio [OR] = 6.15, 95% confidence interval [CI]: 1.87-20.24, P < 0.01) were the two independent risk factors. Patient characteristics were not statistically significant between the recurrence and non-recurrence groups, which included age, sex, CBD diameter, largest CBD stone diameter ≥ 1.2 cm, CBD stone number ≥ 2, muddy stones, initial ampullary intervention (EST, EPBD/EPLBD, and ESBD) and cholecystectomy. In multivariate analysis, the recurrence rate of patients with S type was 16.79 times that of patients with straight type (OR = 16.79, 95%CI: 4.26-66.09, P < 0.01), the recurrence rate of patients with polyline type was 4.97 times that of patients with straight type (OR = 4.97, 95%CI: 1.42-17.38, P = 0.01), and the recurrence rate of S type patients was 3.38 times that of patients with polyline type (OR = 3.38, 95%CI: 1.07-10.72, P = 0.04).
CBD morphology, especially S type and polyline type, is associated with increased recurrence of CBD stones in Billroth II anatomy patients.
Future research with more samples should be undertaken to assess the association between CBD morphology and CBD stone recurrence in patients with or without Billroth II gastrectomy. And periodic surveillance and standard prophylactic therapy should be explored.