Yonsei Med J.  2016 Jan;57(1):132-137. 10.3349/ymj.2016.57.1.132.

Cholecystectomy for Prevention of Recurrence after Endoscopic Clearance of Bile Duct Stones in Korea

• Song ME
• Chung MJ
• Lee DJ
• Oh TG
• Park JY
• Bang S
• Park SW
• Song SY
• Chung JB

• KMID: 2466362
• DOI: http://doi.org/10.3349/ymj.2016.57.1.132

Abstract

PURPOSE
Cholecystectomy in patients with an intact gallbladder after endoscopic removal of stones from the common bile duct (CBD) remains controversial. We conducted a case-control study to determine the risk of recurrent CBD stones and the benefit of cholecystectomy for prevention of recurrence after endoscopic removal of stones from the CBD in Korean patients.
MATERIALS AND METHODS
A total of 317 patients who underwent endoscopic CBD stone extraction between 2006 and 2012 were included. Possible risk factors for the recurrence of CBD stones including previous cholecystectomy history, bile duct diameter, stone size, number of stones, stone composition, and the presence of a periampullary diverticulum were analyzed.
RESULTS
The mean duration of follow-up after CBD stone extraction was 25.4+/-22.0 months. A CBD diameter of 15 mm or larger [odds ratio (OR), 1.930; 95% confidence interval (CI), 1.098 to 3.391; p=0.022] and the presence of a periampullary diverticulum (OR, 1.859; 95% CI, 1.014 to 3.408; p=0.045) were independent predictive factors for CBD stone recurrence. Seventeen patients (26.6%) in the recurrence group underwent elective cholecystectomy soon after endoscopic extraction of CBD stones, compared to 88 (34.8%) in the non-recurrence group; the difference was not statistically significant (p=0.212).
CONCLUSION
A CBD diameter of 15 mm or larger and the presence of a periampullary diverticulum were found to be potential predictive factors for recurrence after endoscopic extraction of CBD stones. Elective cholecystectomy after clearance of CBD stones did not reduce the incidence of recurrent CBD stones in Korean patients.

Keyword

Cholecystectomy; gallstones; common bile duct; recurrence

MeSH Terms

Adult
Aged
Bile Duct Diseases/*diagnosis/epidemiology/surgery
Case-Control Studies
Cholangiopancreatography, Endoscopic Retrograde
Cholecystectomy/*methods
Common Bile Duct/*pathology/radiography
Elective Surgical Procedures
Female
Gallstones/epidemiology/*surgery
Humans
Incidence
Male
Middle Aged
Recurrence
Republic of Korea/epidemiology
Risk Factors
*Sphincterotomy, Endoscopic

Figure

• 

  Fig. 1 Probability of remaining free of common bile duct stone recurrence after endoscopic common bile duct stone extraction in patients who underwent cholecystectomy and those who did not, as determined by Kaplan-Meier analysis.

Reference

1. Classen M, Demling L. [Endoscopic sphincterotomy of the papilla of vater and extraction of stones from the choledochal duct (author's transl)]. Dtsch Med Wochenschr. 1974; 99:496–497.

2. Kawai K, Akasaka Y, Murakami K, Tada M, Koli Y. Endoscopic sphincterotomy of the ampulla of Vater. Gastrointest Endosc. 1974; 20:148–151.

3. Bergman JJ, van der Mey S, Rauws EA, Tijssen JG, Gouma DJ, Tytgat GN, et al. Long-term follow-up after endoscopic sphincterotomy for bile duct stones in patients younger than 60 years of age. Gastrointest Endosc. 1996; 44:643–649.

4. Tanaka M, Takahata S, Konomi H, Matsunaga H, Yokohata K, Takeda T, et al. Long-term consequence of endoscopic sphincterotomy for bile duct stones. Gastrointest Endosc. 1998; 48:465–469.

5. Prat F, Malak NA, Pelletier G, Buffet C, Fritsch J, Choury AD, et al. Biliary symptoms and complications more than 8 years after endoscopic sphincterotomy for choledocholithiasis. Gastroenterology. 1996; 110:894–899.

6. Ando T, Tsuyuguchi T, Okugawa T, Saito M, Ishihara T, Yamaguchi T, et al. Risk factors for recurrent bile duct stones after endoscopic papillotomy. Gut. 2003; 52:116–121.

7. Kim DI, Kim MH, Lee SK, Seo DW, Choi WB, Lee SS, et al. Risk factors for recurrence of primary bile duct stones after endoscopic biliary sphincterotomy. Gastrointest Endosc. 2001; 54:42–48.

8. Sugiyama M, Atomi Y. 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. 2002; 97:2763–2767.

9. Keizman D, Shalom MI, Konikoff FM. An angulated common bile duct predisposes to recurrent symptomatic bile duct stones after endoscopic stone extraction. Surg Endosc. 2006; 20:1594–1599.

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

11. Lee SH, Jung MJ, Hwang HK, Kang CM, Lee WJ. The first experiences of robotic single-site cholecystectomy in Asia: a potential way to expand minimally-invasive single-site surgery? Yonsei Med J. 2015; 56:189–195.

12. Boerma D, Rauws EA, Keulemans YC, Janssen IM, Bolwerk CJ, Timmer R, et al. Wait-and-see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile-duct stones: a randomised trial. Lancet. 2002; 360:761–765.

13. Lau JY, Leow CK, Fung TM, Suen BY, Yu LM, Lai PB, et al. Cholecystectomy or gallbladder in situ after endoscopic sphincterotomy and bile duct stone removal in Chinese patients. Gastroenterology. 2006; 130:96–103.

14. Hammarstrom LE, Holmin T, Stridbeck H. Endoscopic treatment of bile duct calculi in patients with gallbladder in situ: long-term outcome and factors. Scand J Gastroenterol. 1996; 31:294–301.

15. Lai JH, Wang HY, Chang WH, Chu CH, Shih SC, Lin SC. Recurrent cholangitis after endoscopic lithotripsy of common bile duct stones with gallstones in situ: predictive factors with and without subsequent cholecystectomy. J Laparoendosc Adv Surg Tech A. 2012; 22:324–329.

16. Hill J, Martin DF, Tweedle DE. Risks of leaving the gallbladder in situ after endoscopic sphincterotomy for bile duct stones. Br J Surg. 1991; 78:554–557.

17. Lai KH, Lin LF, Lo GH, Cheng JS, Huang RL, Lin CK, et al. Does cholecystectomy after endoscopic sphincterotomy prevent the recurrence of biliary complications? Gastrointest Endosc. 1999; 49(4 Pt 1):483–487.

18. Kwon SK, Lee BS, Kim NJ, Lee HY, Chae HB, Youn SJ, et al. Is cholecystectomy necessary after ERCP for bile duct stones in patients with gallbladder in situ? Korean J Intern Med. 2001; 16:254–259.

19. Cui ML, Cho JH, Kim TN. Long-term follow-up study of gallbladder in situ after endoscopic common duct stone removal in Korean patients. Surg Endosc. 2013; 27:1711–1716.

20. Heo J, Jung MK, Cho CM. Should prophylactic cholecystectomy be performed in patients with concomitant gallstones after endoscopic sphincterotomy for bile duct stones? Surg Endosc. 2015; 29:1574–1579.

21. Lobo DN, Balfour TW, Iftikhar SY, Rowlands BJ. Periampullary diverticula and pancreaticobiliary disease. Br J Surg. 1999; 86:588–597.

22. Boix J, Lorenzo-Zúñiga V, Añaños F, Domènech E, Morillas RM, Gassull MA. Impact of periampullary duodenal diverticula at endoscopic retrograde cholangiopancreatography: a proposed classification of periampullary duodenal diverticula. Surg Laparosc Endosc Percutan Tech. 2006; 16:208–211.

23. Pereira-Lima JC, Jakobs R, Winter UH, Benz C, Martin WR, Adamek HE, et al. Long-term results (7 to 10 years) of endoscopic papillotomy for choledocholithiasis. Multivariate analysis of prognostic factors for the recurrence of biliary symptoms. Gastrointest Endosc. 1998; 48:457–464.

24. Geenen DJ, Geenen JE, Jafri FM, Hogan WJ, Catalano MF, Johnson GK, et al. The role of surveillance endoscopic retrograde cholangiopancreatography in preventing episodic cholangitis in patients with recurrent common bile duct stones. Endoscopy. 1998; 30:18–20.

25. Kim MH, Myung SJ, Seo DW, Lee SK, Kim YS, Lee MH, et al. Association of periampullary diverticula with primary choledocholithiasis but not with secondary choledocholithiasis. Endoscopy. 1998; 30:601–604.

26. Tsai TJ, Lai KH, Lin CK, Chan HH, Wang EM, Tsai WL, et al. The relationship between gallbladder status and recurrent biliary complications in patients with choledocholithiasis following endoscopic treatment. J Chin Med Assoc. 2012; 75:560–566.

27. Leiss O, von Bergmann K. Effect of Rowachol on biliary lipid secretion and serum lipids in normal volunteers. Gut. 1985; 26:32–37.

28. Baek YH, Kim HJ, Park JH, Park DI, Cho YK, Sohn CI, et al. [Risk factors for recurrent bile duct stones after endoscopic clearance of common bile duct stones]. Korean J Gastroenterol. 2009; 54:36–41.