Causes associated with recurrent choledocholithiasis following therapeutic endoscopic retrograde cholangiopancreatography: A large sample sized retrospective study

Table 1 General characteristics compared between the recurrence group and control group

Variable	Recurrence group (n = 477)	Control group (n = 477)	OR (95%CI)	P-value
Sex (male/female)	216/261	229/248	1.116 (0.865-1.439)	0.399
Age > 65 yr (Y/N)	181/296	134/343	2.437 (1.818-3.266)	0.000
Weight (kg), mean ± SD	57.94 ± 16.80	58.24 ± 11.31	0.992 (0.980-1.004)	0.196
1Recurrence time (d), mean ± SD	17.77 ± 19.30	17.85 ± 17.25	1.000 (0.993-1.007)	0.950
History of drinking (Y/N)	42/423	61/416	0.677 (0.447-1.026)	0.066
History of smoking (Y/N)	69/395	86/391	0.794 (0.562-1.123)	0.192

¹Recurrence time was defined as time from the onset of stone removal to recurrence. OR: Odds ratio; 95%CI: 95% confidence interval; Y: Yes; N: No.

Table 2 Past medical history compared between the recurrence group and control group

Variable	Recurrence group (n = 477)	Control group (n = 477)	OR (95%CI)	P-value
Hypertension (Y/N)	84/393	63/414	1.405 (0.985-2.002)	0.060
Diabetes (Y/N)	34/441	26/452	1.334 (0.788-2.261)	0.284
Hepatitis B (Y/N)	37/440	34/438	1.083 (0.668-1.758)	0.746
Fatty liver (Y/N)	15/462	23/454	0.641 (0.330-1.244)	0.189
Liver cirrhosis (Y/N)	17/460	10/461	1.704 (0.772-3.760)	0.187
Cholecystectomy (Y/N)	252/225	212/265	1.400 (1.085-1.806)	0.010
Biliary-enteric anastomosis (Y/N)	5/471	2/475	2.521 (0.487-13.06)	0.270
Choledocholithotomy (Y/N)	88/389	31/446	3.255 (2.114-5.010)	0.000

Y: Yes; N: No.

Table 3 Endoscopic retrograde cholangiopancreatography-related factors compared between the recurrence group and control group

Variable	Recurrence group (n = 477)	Control group (n = 477)	OR (95%CI)	P-value
EML (Y/N)	74/391	40/437	2.068 (1.375-3.110)	0.000
EPBD (Y/N)	111/345	25/461	5.669 (3.594-8.941)	0.000
EST (Y/N)	404/60	382/96	1.701 (1.197-2.417)	0.003
CBD stent implantation (Y/N)	130/334	45/432	3.737 (2.587-5.398)	0.000
ENBD (Y/N)	271/192	282/195	0.976 (0.753-1.266)	0.855
ERCP procedures, mean ± SD	1.38 ± 0.55	1.14 ± 0.39	3.043 (2.242-4.130)	0.000

ERCP: Endoscopic retrograde cholangiopancreatography; EML: Endoscopic mechanical lithotripsy; EPBD: Endoscopic papillary balloon dilation; EST: Endoscopic sphincterotomy; CBD: Common bile duct; ENBD: Endoscopic nasobiliary drainage; Y: Yes; N: No.

Table 4 Common bile duct-related factors compared between the recurrence group and control group

Variable	Recurrence group (n = 477)	Control group (n = 477)	OR (95%CI)	P-value
Gallstones (Y/N)	274/203	272/205	1.017 (0.787-1.315)	0.896
Intrahepatic bile duct stones (Y/N)	133/344	60/417	2.687 (1.919-3.762)	0.000
Ectopic duodenal papilla (Y/N)	3/462	1/476	3.091 (0.32-29.822)	0.329
Duodenal ulcers (Y/N)	21/443	26/451	0.822 (0.456-1.483)	0.516
PAD (Y/N)	188/276	142/335	1.607 (1.227-2.105)	0.001
Bile duct angle (Y/N)	36/429	25/452	1.517 (0.896-2.570)	0.121
CBD diameter (cm), mean ± SD	1.27±0.73	1.01±0.55	1.988 (1.589-2.486)	0.000
Choledocholithiasis diameter ≥ 10 mm (Y/N)	229/134	126/236	1.580 (1.202-2.067)	0.001
Number of stones (n), (mean ± SD)	1.90 ± 1.19	1.82 ± 1.02	1.12 (0.992-1.265)	0.067
Biliary tract infections (Y/N)	46/418	20/457	2.515 (1.463-4.321)	0.001
Bile-duct duodenal fistula (Y/N)	22/442	10/467	2.324 (1.088-4.964)	0.029
CBD stenosis (Y/N)	51/413	33/444	1.661 (1.051-2.626)	0.030

PAD: Periampullary diverticula; CBD: Common bile duct; Y: Yes; N: No.

Table 5 Laboratory indicators and treatment compared between the recurrence group and control group

Variable	Recurrence group (n = 477)	Control group (n = 477)	OR (95%CI)	P-value
TBi (umol/L), mean ± SD	53.02 ± 69.91	102.47 ± 126.1	1.000 (0.999-1.001)	0.795
DBi (umol /L), mean ± SD	31.41 ± 44.64	71.21 ± 126.1	1.000 (0.998-1.002)	0.961
ALT (U/L), mean ± SD	129.3 ± 142.91	98.39 ± 127.62	0.999 (0.998-1.000)	0.201
AST (U/L), mean ± SD	96.99 ± 132.68	64.86 ± 103.69	0.999 (0.998-1.000)	0.123
GGT (U/L), mean ± SD	288.3 ± 262.92	306.3 ± 267.96	1.000 (1.000-1.001)	0.441
Cholesterol (mmol /L), mean ± SD	4.77 ± 14.09	4.33 ± 1.53	0.990 (0.886-1.105)	0.852
Triglyceride (mmol /L), mean ± SD	1.30 ± 0.82	1.43 ± 0.85	0.888 (0.742-1.063)	0.197
Used antibiotics before ERCP (Y/N)	336/141	387/85	0.523 (0.385-0.711)	0.000

TBi: Total bilirubin; DBi: Direct bilirubin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyltransferase; ERCP: Endoscopic retrograde cholangiopancreatography; Y: Yes; N: No.

Table 6 Multivariate stepwise logistic regression analysis for the recurrence of choledocholithiasis

Variable	OR (95%CI)	P-value
Age > 65 yr	1.556 (1.079-2.244)	0.018
Choledocholithotomy	2.474 (1.417-4.320)	0.001
EPBD	5.545 (3.026-10.162)	0.000
EST	3.378 (1.968-5.797)	0.000
CBD stent implantation	5.562 (3.326-9.301)	0.000
ERCP procedures	2.601 (1.778-3.805)	0.000
Stones in the intrahepatic bile duct	2.359 (1.516-3.668)	0.000
PAD	1.579 (1.090-2.289)	0.016
Choledocholithiasis diameter ≥ 10 mm	1.435 (1.094-1.883)	0.009
Biliary-duodenal fistula	2.720 (1.094-6.765)	0.031
Used antibiotics before ERCP	0.527 (0.346-0.801)	0.003
Biliary tract infections	1.059 (1.021-1.099)	0.003

ERCP: Endoscopic retrograde cholangiopancreatography; EPBD: Endoscopic papillary balloon dilation; EST: Endoscopic sphincterotomy; CBD: Common bile duct; PAD: Periampullary diverticula.