Common bile duct morphology is associated with recurrence of common bile duct stones in Billroth II anatomy patients

doi:10.12998/wjcc.v9.i26.7671

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World Journal of Clinical Cases

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World J Clin Cases. Sep 16, 2021; 9(26): 7671-7681
Published online Sep 16, 2021. doi: 10.12998/wjcc.v9.i26.7671

Table 1 Patient characteristics

	n (%)
Patients	138
Male	107 (77.5)
Age (mean ± SD, yr)	72.3 ± 10.5
PAD	40 (29.0)
CBD diameter (mean ± SD, cm)	1.4 ± 0.6
CBD diameter ≥ 1.2 cm	110 (79.7)
CBD diameter ≥ 1.5 cm	73 (52.9)
Largest CBD stone diameter ≥ 1.2 cm	68 (49.3)
CBD stone number ≥ 2	56 (40.6)
Muddy stones	20 (14.5)
Initial ampullary intervention
EST	8 (5.8)
EPBD/EPLBD	79 (57.2)
ESBD	28 (20.3)
CBD morphology
Straight type	69 (50.0)
S type	22 (15.9)
Polyline type	47 (34.1)
Cholecystectomy	8 (5.8)
Procedure time (mean ± SD, min)	38.3 ± 19.5

SD: Standard deviation; 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 Characteristics of patients with and without common bile duct stone recurrence

	Recurrence (n = 27)	Non-recurrence (n = 111)	P value
Sex (male/female)	21/6	86/25	0.97
Age (mean ± SD, yr)	71.9 ± 10.2	72.4 ± 10.6	0.82
PAD, n (%)	12 (44.4)	28 (25.2)	0.05
CBD diameter (mean ± SD, cm)	1.5 ± 0.6	1.4 ± 0.4	0.29
CBD diameter ≥ 1.2 cm, n (%)	27 (100.0)	83 (74.8)	< 0.01
CBD diameter ≥ 1.5 cm, n (%)	23 (85.2)	50 (45.0)	< 0.01
Largest CBD stone diameter ≥ 1.2 cm, n (%)	14 (51.9)	54 (48.6)	0.77
CBD stone number ≥ 2, n (%)	13 (48.1)	43 (38.7)	0.37
Muddy stones, n (%)	4 (14.8)	16 (14.4)	1.00
Initial ampullary intervention, n (%)
EST	2 (7.4)	6 (5.4)	1.00
EPBD/EPLBD	15 (55.6)	64 (57.7)	0.84
ESBD	6 (22.2)	22 (19.8)	0.78
CBD morphology, n (%)			< 0.01
Straight type	4 (14.8)	65 (58.6)
S type	12 (44.4)	10 (9.0)
Polyline type	11 (40.7)	36 (32.4)
Cholecystectomy, n (%)	3 (11.1)	5 (4.5)	0.39
Procedure time (mean ± SD, min)	44.9 ± 22.7	36.7 ± 18.4	0.05

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 Characteristics of patients with different common bile duct morphologies

	Straight type (n = 69)	S type (n = 22)	Polyline type (n = 47)	P value
Sex (male/female)	49/20	18/4	40/7	0.19
Age (mean ± SD, yr)	72.6 ± 10.9	71.8 ± 10.6	72.0 ± 10.0	0.93
PAD: n (%)	20 (29.0)	9 (40.9)	11 (23.4)	0.33
CBD diameter (mean ± SD, cm)	1.5 ± 0.5	1.8 ± 0.6	1.6 ± 0.5	< 0.01
CBD diameter ≥ 1.2 cm, n (%)	49 (71.0)	22 (100.0)	39 (83.0)	< 0.01
CBD diameter ≥ 1.5 cm, n (%)	32 (46.4)	16 (72.7)	25 (53.2)	0.10
Largest CBD stone diameter ≥ 1.2 cm, n (%)	32 (46.4)	10 (45.5)	26 (55.3)	0.59
CBD stone number ≥ 2, n (%)	27 (39.1)	13 (59.1)	16 (34.0)	0.13
Muddy stones, n (%)	12 (17.4)	2 (9.1)	6 (12.8)	0.68
Initial ampullary intervention, n (%)
EST	3 (4.3)	2 (9.1)	3 (6.4)	0.62
EPBD/EPLBD	39 (56.5)	14 (63.6)	26 (55.3)	0.80
ESBD	15 (21.7)	3 (13.6)	10 (21.3)	0.78
Cholecystectomy, n (%)	3 (4.3)	2 (9.1)	3 (6.4)	0.62
Procedure time (mean ± SD, min)	34.9 ± 15.7	49.1 ± 27.8	38.4 ± 18.6	0.07

Table 4 Characteristics of patients with single recurrence and multiple recurrences

	Single recurrence (n = 20)	Multiple recurrences (n = 7)	P value
Sex (male/female)	15/5	6/1	1.00
Age (mean ± SD, yr)	72.7 ± 8.9	69.4 ± 13.8	0.48
PAD, n (%)	11 (55.0)	1 (14.3)	0.09
CBD diameter (mean ± SD, cm)	1.9 ± 0.4	2.0 ± 0.8	0.73
CBD diameter ≥ 1.2 cm, n (%)	20 (100.0)	7 (100.0)
CBD diameter ≥ 1.5 cm, n (%)	18 (90.0)	5 (71.4)	0.27
Largest CBD stone diameter ≥ 1.2 cm, n (%)	9 (45.0)	5 (71.4)	0.39
CBD stone number ≥ 2, n (%)	10 (50.0)	3 (42.9)	1.00
Muddy stones, n (%)	4 (20.0)	0 (0.0)	0.55
Initial ampullary intervention, n (%)
EST	2 (10.0)	0 (0.0)	1.00
EPBD/EPLBD	11 (55.0)	4 (57.1)	1.00
ESBD	4 (20.0)	2 (28.6)	0.63
CBD morphology, n (%)			1.00
Straight type	3 (15.0)	1 (14.3)
S type	9 (45.0)	3 (42.9)
Polyline type	8 (40.0)	3 (42.9)
Cholecystectomy, n (%)	3 (15.0)	0 (0.0)	0.55
Procedure time (mean ± SD, min)	45.8 ± 17.0	42.4 ± 36.0	0.82
Follow-up period (mean ± SD, yr)	19.0 ± 10.6	20.1 ± 7.7	0.80

Table 5 Risk factors for common bile duct stone recurrence

Factor	β	OR (95%CI)	P value	β	OR (95%CI)	P value
PAD	0.55	1.74 (0.61-4.95)	0.30
Procedure time	0.01	1.01 (0.98-1.03)	0.84
CBD diameter ≥ 1.5 cm	1.82	6.15 (1.87-20.24)	< 0.01
		Model 1			Model 2
CBD morphology			< 0.01			< 0.01
Straight type		Reference		-1.60	0.20 (0.06-0.70)	0.01
S type	2.82	16.79 (4.27-66.09)	< 0.01	1.22	3.38 (1.07-10.72)	0.04
Polyline type	1.60	4.97 (1.42-17.38)	0.01		Reference

PAD: Periampullary diverticulum; CBD: Common bile duct; OR: Odds ratio; CI: Confidence interval.

Citation: Ji X, Jia W, Zhao Q, Wang Y, Ma SR, Xu L, Kan Y, Cao Y, Fan BJ, Yang Z. Common bile duct morphology is associated with recurrence of common bile duct stones in Billroth II anatomy patients. World J Clin Cases 2021; 9(26): 7671-7681
URL: https://www.wjgnet.com/2307-8960/full/v9/i26/7671.htm
DOI: https://dx.doi.org/10.12998/wjcc.v9.i26.7671