Skip to main content

Risk Factors for Recurrent Common Bile Duct Stones After Endoscopic Retrograde Cholangiopancreatography


Patients with common bile duct stones (CBDS) are susceptible to recurrence after complete stone removal with endoscopic retrograde cholangiopancreatography (ERCP). Our study aims to analyze the potential risk factors for the recurrence of choledocholithiasis after endoscopic treatment. From January 2016 to January 2018, a total of 315 eligible patients who underwent ERCP at Nantong First People’s Hospital were evaluated and followed up. The clinical data recorded in this study included general characteristics, medical history, ERCP-related factors, CBDS-related factors, and laboratory/imaging indicators. The patients were divided into a recurrence group and a nonrecurrence group, and then, logistic regression analysis and Kaplan–Meier analysis were used to identify the risk factors for stone recurrence after ERCP. CBDS recurred after ERCP in 48 patients (15.24%). The data from the recurrence group and nonrecurrence group showed significant differences in age, common bile duct diameter (≥ 15 mm), number of stones (≥ 2), periampullary diverticulum (PAD), history of biliary surgery, bile duct stenosis, and duodenal papillary stenosis (p < 0.05). Patients with the following risk factors were found to be more susceptible to recurrence after ERCP treatment: wider common bile duct, multiple stones, PAD, biliary surgery history, bile duct stricture, and duodenal papilla stenosis.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

Data Availability

Data are available upon request.

Code Availability

Not applicable.


  1. Kim DI, Kim M-H, Lee SK et al (2001) Risk factors for recurrence of primary bile duct stones after endoscopic biliary sphincterotomy. Gastrointest Endosc 54(1):42–48.

    CAS  Article  PubMed  Google Scholar 

  2. Cotton PB, Lehman G, Vennes J et al (1991) Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 37(3):383–393.

    CAS  Article  PubMed  Google Scholar 

  3. Sugiyama M, Atomi Y (2002) Risk factors predictive of late complications after endoscopic sphincterotomy for bile duct stones: long-term (more than 10 years) follow-up study. Am J Gastroenterol 97(11):2763–2767.

    Article  PubMed  Google Scholar 

  4. Konstantakis C, Triantos C, Theopistos V et al (2017) Recurrence of choledocholithiasis following endoscopic bile duct clearance: long term results and factors associated with recurrent bile duct stones. World J Gastrointest Endosc 9(1):26–33.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Parra-Membrives Pablo M-BD, Manuel L-H et al (2019) Choledocholithiasis recurrence following laparoscopic common bile duct exploration. Cir Esp 97(6):336–342.

    CAS  Article  PubMed  Google Scholar 

  6. Fritz E, Kirchgatterer A, Hubner D et al (2006) ERCP is safe and effective in patients 80 years of age and older compared with younger patients. Gastrointest Endosc 64(6):899–905.

    Article  PubMed  Google Scholar 

  7. Ueno N, Ozawa Y, Aizawa T (2003) Prognostic factors for recurrence of bile duct stones after endoscopic treatment by sphincter dilation. Gastrointest Endosc 58(3):336–340.

    Article  PubMed  Google Scholar 

  8. Pereira Lima JC, Jakobs R, Winter UH (1998) Long term results (7 to 10 years) of endoscopic papillotomy for choledocholithiasis. Gastrointest Endosc 48:457.

    CAS  Article  PubMed  Google Scholar 

  9. Sugiyama M, Suzuki Y, Abe N et al (2004) Endoscopic retreatment of recurrent choledocholithiasis after sphincterotomy. Gut 53(12):1856–1859.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. Wu Y, Xu CJ, Xu SF (2021) Advances in risk factors for recurrence of common bile duct stones. Int J Med Sci 18(4):1067–1074.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. Cheon YK, Lehman GA (2006) Identification of risk factors for stone recurrence after endoscopic treatment of bile duct stones. Eur J Gastroenterol Hepatol 18(5):461–464.

    Article  PubMed  Google Scholar 

  12. Cai JS, Qiang S, Bao-Bing Y (2017) Advances of recurrent risk factors and management of choledocholithiasis. Scand J Gastroenterol 52(1):34–43.

    Article  PubMed  Google Scholar 

  13. Yang J, Peng J-Y, Pang E-J et al (2013) Efficacy of endoscopic nasobiliary drainage for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis and cholangitis after repeated clearance of common bile duct stones: experience from a Chinese center. Dig Endosc 25(4):453–458.

    Article  PubMed  Google Scholar 

  14. Ryoma E, Akihiko S, Tanaka Yu et al (2020) Saline solution irrigation of the bile duct after stone removal reduces the recurrence of common bile duct stones. Tohoku J Exp Med 250(3):173–179.

    Article  Google Scholar 

  15. Choi JH, Lee TY, Cheon YK (2021) Effect of stent placement on stone recurrence and post-procedural cholangitis after endoscopic removal of common bile duct stones. The Korean J Intern Med 36(Suppl 1):S27–S34.

    Article  PubMed  Google Scholar 

  16. Kaneko J, Kawata K, Watanabe S et al (2018) Clinical characteristics and risk factors for stent-stone complex formation following biliary plastic stent placement in patients with common bile duct stones. J Hepatobiliary Pancreat Sci 25:448–454.

    Article  PubMed  Google Scholar 

  17. Kawaji Y, Isayama H, Nakai Y et al (2019) Multiple recurrences after endoscopic removal of common bile duct stones: a retrospective analysis of 976 cases. J Gastroenterol Hepatol 34(8):1460–1466.

    Article  PubMed  Google Scholar 

  18. Reinders JSK, Goud A, Timmer R et al (2010) Early laparoscopic cholecystectomy improves outcomes after endoscopic sphincterotomy for choledochocystolithiasis. Gastroenterology 138(7):2315–2320.

    Article  PubMed  Google Scholar 

  19. Park SY, Hong TH, Lee SK et al (2019) Recurrence of common bile duct stones following laparoscopic common bile duct exploration: a multicenter study. J Hepatobiliary Pancreat Sci 26(12):578–582.

    Article  PubMed  Google Scholar 

  20. Yoo ES, Yoo BM, Kim JH et al (2018) Evaluation of risk factors for recurrent primary common bile duct stone in patients with cholecystectomy. Scand J Gastroenterol 53(4):466–470.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations



(I) Conception and design: Ting Dai; (II) administrative support: Junbo Qian; (III) provision of study materials or patients: Junbo Qian; (IV) collection and assembly of data: Ting Dai, Shengkui Qiu; (V) data analysis and interpretation: Ting Dai, Shengkui Qiu; (VI) manuscript writing: All authors; (VII) final approval of manuscript: All authors. The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Junbo Qian.

Ethics declarations

Ethics Approval

The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This study was approved by the Ethics Committee of the Second Affiliated Hospital of Nantong University (No. 2016YXJS006).

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Dai, T., Qiu, S. & Qian, J. Risk Factors for Recurrent Common Bile Duct Stones After Endoscopic Retrograde Cholangiopancreatography. Indian J Surg (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI:


  • Common bile duct stones (CBDS)
  • Recurrence
  • Endoscopic retrograde cholangiopancreatography (ERCP)