Factors Affecting Recurrent Choledocholithiasis After Endoscopic Biliary Sphincterotomy: A Cross-Sectional Study

Aim: The purpose of this study was to identify and analyze factors associated with the recurrence of common bile duct stones (CBDS) following endoscopic interventions, aiming to provide insights into predictors and characteristics of CBDS recurrence after endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) procedures.Methods: The study was designed as a single-center, cross-sectional study. Clinical data were collected from 271 patients with CBDS who underwent ERCP between June 2019 and December 2022. According to the diagnostic criteria for CBDS recurrence, patients were categorized into recurrence and non-recurrence groups. The assessment of predisposing risk factors for recurrent bile duct stones included various variables such as age, sex, gallbladder status, presence of periampullary diverticulum (PAD), number and diameter of bile duct stones, bile duct diameter, pre-cutting, and early complications.Results: A total of 271 patients were included in the study. CBDS recurrence occurred in 25 patients (9.2%), with a median of 18 months after ERCP and EST. Notable findings included that patients with recurrent CBDS had larger common bile duct diameters (7.5 +/- 4.5 mm vs 13 +/- 1.7 mm, p=0.037). Choledocholithiasis was more common in patients with a choledochal duct diameter >= 1.5 cm (3% vs 48%, p=0.00001). Recurrent choledocholithiasis was frequent in patients with larger stone sizes (7.3 +/- 6.5 mm vs 13.5 +/- 4.3 mm, p=0.04). The presence of PAD was correlated with a higher recurrence risk (23% vs 44%, p=0.013). The time to stone recurrence after the index ERCP and EST was 18.273 +/- 2.021 months. There was no significant difference in recurrence between patients with >= 2 CBDS and those with a single stone (41% vs 44%, p=0.35).Conclusion: Larger bile duct diameter, choledochal stone size, initial stone size, and the presence of PAD emerged as crucial indicators of recurrence risk. These findings contribute to our understanding of the prediction and management of CBDS recurrence after ERCP and EST procedures.

Automated summary

This study aimed to identify factors associated with the recurrence of common bile duct stones (CBDS) following endoscopic interventions. The results showed that larger bile duct diameter, choledochal stone size, initial stone size, and the presence of periampullary diverticulum (PAD) emerged as crucial indicators of recurrence risk.