Short-term Clinical Outcomes Based on Risk Factors of Recurrence after Removing Common Bile Duct Stones with Endoscopic Papillary Large Balloon Dilatation

ABSTRACT

BACKGROUND/AIMS: Recurrence is an important late complication of endotherapy of bile duct stones. Endoscopic papillary large balloon dilation (EPLBD) can be used as an alternative method of removing difficult bile duct stones. The aim of this study was to evaluate short term clinical outcomes after removing common bile duct (CBD) stones using EPLBD. METHODS: A retrospective review was performed based on the medical records of 141 patients who received EPLBD, with or without endoscopic sphincterotomy, between September 2008 and February 2010. Of these, 50 patients, were enrolled in the study. Clinical and endoscopic parameters were analyzed to identify risk factors for CBD stones recurrence. RESULTS: MaleFemale ratio was 2228 (mean age, 67.4+/-14.4 years). Recurrence rate was 24.0% (12/50). Mean follow-up period was 10.8+/-4.5 months. Nineteen (38.0%) had a history of surgery and 20 (40.0%) were comorbid with periampullary diverticula. Mean diameters of the stones and CBD were 13.8+/-4.3 mm and 20.1+/-7.2 mm, respectively. In univariate analysis, large CBD stones (> or =12 mm) and angulated CBD (angle < or =145degrees) were identified as the significant predictors of recurrence. In multivariate analysis, angulated CBD (angle < or =145degrees) was the significant independent risk factor for recurrence. CONCLUSIONS: Close follow-up seems necessary in patients with angulated CBD (angle < or =145degrees).