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An angulated common bile duct predisposes to recurrent symptomatic bile duct stones after endoscopic stone extraction

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Abstract

Background

Endoscopic sphincterotomy and stone extraction are standard procedures for the removal of bile duct stones. Stone recurrence can, however, occur in up to 25% of cases. Risk factors have been poorly defined, but are believed to be related to bile stasis. This study investigated whether an angulated common bile duct (CBD) that may predispose to bile stasis influences symptomatic stone recurrence after successful endoscopic therapy.

Methods

This study included 232 consecutive patients (mean age, 64.1 years; 86 men) who had undergone therapeutic endoscopic retrograde cholangiopancreatography for bile duct stones. Data from the follow-up period (36 ± 17 months) were obtained from medical records and patient questioning. Common bile duct angulation and diameter were measured from the cholangiogram after stone removal.

Results

Symptomatic bile duct stones recurred in 16% of the patients (36/232). Three independent risk factors were identified by multivariate analysis: an angulated CBD (angle, ≤145°; relative risk [RR], 5.2; 95% confidence interval [CI], 2.2–12.5; p = 0.0002), a dilated CBD (diameter, ≥13 mm; RR, 2.6; 95% CI, 1.2–5.7; p = 0.017), and a previous open cholecystectomy (RR, 2.7; 95% CI, 1.3–5.9; p = 0.0117). Gender, age, urgency of procedure, or a periampullary diverticulum did not influence the recurrence rate.

Conclusions

Angulation of the CBD (≤145°) on endoscopic cholangiography, a dilated CBD, and a previous open cholecystectomy are independent risk factors for symptomatic recurrence of bile duct stones. The findings support the role of bile stasis in stone recurrence. Further studies using these data prospectively to identify high-risk patients are warranted.

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Acknowledgments

The authors thank Drs. Y. Rattan, A. Hallak, and M. Santo for performing some of the endoscopic procedures.

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Authors and Affiliations

  1. Department of Gastroenterology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 64239, Israel

    D. Keizman & M. I. Shalom

  2. The Minerva Center for Cholesterol Gallstones and Lipid Metabolism in the Liver, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel

    F. M. Konikoff

  3. Department of Gastroenterology and Hepatology, Meir Medical Center, 59 Tshernichovsky Street, Kfar Saba, 44281, Israel

    F. M. Konikoff

Authors
  1. D. Keizman
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  2. M. I. Shalom
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  3. F. M. Konikoff
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Corresponding author

Correspondence to F. M. Konikoff.

Additional information

Part of this work was presented at the Digestive Disease Week in New Orleans, 16–20 May 2004, and published in abstract form in Gastrointestinal Endoscopy 2004;59: AB197

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Keizman, D., Shalom, M.I. & Konikoff, F.M. An angulated common bile duct predisposes to recurrent symptomatic bile duct stones after endoscopic stone extraction. Surg Endosc 20, 1594–1599 (2006). https://doi.org/10.1007/s00464-005-0656-x

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  • DOI: https://doi.org/10.1007/s00464-005-0656-x

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