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Yan C, Zheng J, Tang H, Fang C, Zhu J, Feng H, Huang H, Su Y, Wang G, Wang C. Prediction for post-ERCP pancreatitis in non-elderly patients with common bile duct stones: a cross-sectional study at a major Chinese tertiary hospital (2015-2023). BMC Med Inform Decis Mak 2024; 24:143. [PMID: 38807169 PMCID: PMC11134846 DOI: 10.1186/s12911-024-02541-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 05/17/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Post-ERCP pancreatitis is one of the most common adverse events in ERCP-related procedures. The purpose of this study is to construct an online model to predict the risk of post-ERCP pancreatitis in non-elderly patients with common bile duct stones through screening of relevant clinical parameters. METHODS A total of 919 cases were selected from 7154 cases from a major Chinese tertiary hospital. Multivariable logistic regression model was fitted using the variables selected by the LASSO regression from 28 potential predictor variables. The internal and external validation was assessed by evaluating the receiver operating characteristic curve and the area under curve. Restricted cubic spline modelling was used to explore non-linear associations. The interactive Web application developed for risk prediction was built using the R "shiny" package. RESULTS The incidence of post-ERCP pancreatitis was 5.22% (48/919) and significantly higher in non-elderly patients with female, high blood pressure, the history of pancreatitis, difficult intubation, endoscopic sphincterotomy, lower alkaline phosphatase and smaller diameter of common bile duct. The predictive performance in the test and external validation set was 0.915 (95% CI, 0.858-0.972) and 0.838 (95% CI, 0.689-0.986), respectively. The multivariate restricted cubic spline results showed that the incidence of pancreatitis was increased at 33-50 years old, neutrophil percentage > 58.90%, hemoglobin > 131 g/L, platelet < 203.04 or > 241.40 × 109/L, total bilirubin > 18.39 umol / L, aspartate amino transferase < 36.56 IU / L, alkaline phosphatase < 124.92 IU / L, Albumin < 42.21 g / L and common bile duct diameter between 7.25 and 10.02 mm. In addition, a web server was developed that supports query for immediate PEP risk. CONCLUSION The visualized networked version of the above model is able to most accurately predict the risk of PEP in non-elderly patients with choledocholithiasis and allows clinicians to assess the risk of PEP in real time and provide preventive treatment measures as early as possible.
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Affiliation(s)
- Chaoqun Yan
- Department of Biliary and Pancreatic Surgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
| | - Jinxin Zheng
- School of Global Health, Chinese Centre for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Haizheng Tang
- Department of Biliary and Pancreatic Surgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
| | - Changjian Fang
- Department of Pediatric Surgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
| | - Jiang Zhu
- Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hu Feng
- Department of Biliary and Pancreatic Surgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
| | - Hao Huang
- Department of Biliary and Pancreatic Surgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
| | - Yilin Su
- Department of Pediatric Surgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China.
| | - Gang Wang
- Department of Biliary and Pancreatic Surgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China.
| | - Cheng Wang
- Department of Biliary and Pancreatic Surgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China.
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Cao Z, Zhou J, Wei L, He HY, Li J. Effect of the extrahepatic bile duct anatomy on choledocholithiasis and its clinical significance. World J Gastrointest Surg 2024; 16:1363-1370. [PMID: 38817273 PMCID: PMC11135295 DOI: 10.4240/wjgs.v16.i5.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/07/2024] [Accepted: 04/03/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND A comprehensive understanding of the extrahepatic bile duct anatomy is vital to guide surgical procedures and perform endoscopic retrograde cholangiography. Anatomical irregularities within the extrahepatic bile duct may increase susceptibility to bile duct stones. AIM To investigate the anatomical risk factors associated with extrahepatic bile ducts in patients diagnosed with choledocholithiasis, with a specific focus on preventing stone recurrence after surgical intervention and endoscopic lithotomy. METHODS We retrospectively analyzed the medical records of 124 patients without choledocholithiasis and 108 with confirmed choledocholithiasis who underwent magnetic resonance cholangiopancreatography examinations at our center between January 2022 and October 2022. Logistic regression analyses were conducted to identify the anatomical risk factors influencing the incidence of common bile duct stones. RESULTS Multivariate logistic regression analysis revealed that several factors independently contributed to choledocholithiasis risk. Significant independent risk factors for choledocholithiasis were diameter of the common hepatic [adjusted odds ratio (aOR) = 1.43, 95% confidence interval (CI): 1.07-1.92, adjusted P value = 0.016] and common bile (aOR = 1.68, 95%CI: 1.27-2.23, adjusted P value < 0.001) ducts, length of the common hepatic duct (aOR = 0.92, 95%CI: 0.84-0.99, adjusted P value = 0.034), and angle of the common bile duct (aOR = 0.92, 95%CI: 0.89-0.95, adjusted P value < 0.001). CONCLUSION The anatomical features of the extrahepatic bile duct were directly associated with choledocholithiasis risk. Key risk factors include an enlarged diameter of the common hepatic and bile ducts, a shorter length of the common hepatic duct, and a reduced angle of the common bile duct.
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Affiliation(s)
- Zheng Cao
- Department of Gastroenterology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650000, Yunnan Province, China
| | - Jia Zhou
- Department of Gastroenterology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650000, Yunnan Province, China
| | - Li Wei
- Department of Gastroenterology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650000, Yunnan Province, China
| | - Hai-Yu He
- Department of Gastroenterology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650000, Yunnan Province, China
| | - Jun Li
- Department of Gastroenterology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650000, Yunnan Province, China
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Bian H, Zhang L, Yao Y, Lv F, Wei J. How traditional Chinese medicine can prevent recurrence of common bile duct stones after endoscopic retrograde cholangiopancreatography? Front Pharmacol 2024; 15:1363071. [PMID: 38659575 PMCID: PMC11039848 DOI: 10.3389/fphar.2024.1363071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/20/2024] [Indexed: 04/26/2024] Open
Abstract
Common bile duct stones, as a type of cholelithiasis, are a benign biliary obstruction that easily acute abdominalgia, and Endoscopic Retrograde Cholangiopancreatography (ERCP) is usually the first choice for clinical treatment. However, the increasing recurrence rate of patients after treatment is troubling clinicians and patients. For the prevention of recurrence after ERCP, there is no guideline to provide a clear drug regimen, traditional Chinese medicine however has achieved some result in the treatment of liver-related diseases based on the "gut-liver-bile acid axis". On the basis of this, this article discusses the possibility of traditional Chinese medicine to prevent common bile duct stones (CBDS) after ERCP, and we expect that this article will provide new ideas for the prevention of recurrence of CBDS and for the treatment of cholelithiasis-related diseases with traditional Chinese medicine in future clinical and scientific research.
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Affiliation(s)
- Haoyu Bian
- Department of Gastroenterology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Liping Zhang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yupu Yao
- Department of Gastroenterology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Fuqi Lv
- Department of Gastroenterology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Jiaoyang Wei
- Department of Gastroenterology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
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Fu B, Zhang Z, Ji H, Hou Y. Choledochoscopic lithotomy for the treatment of massive common-bile-duct stones: A case report and literature review. Asian J Surg 2024; 47:1959-1960. [PMID: 38212216 DOI: 10.1016/j.asjsur.2023.12.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/25/2023] [Indexed: 01/13/2024] Open
Affiliation(s)
- Bing Fu
- Department of Hepatobiliary Surgery, Tongling People's Hospital, Tongling, 244000, Anhui Province, China
| | - Zhengdong Zhang
- Department of Hepatobiliary Surgery, Tongling People's Hospital, Tongling, 244000, Anhui Province, China
| | - Hui Ji
- Department of Hepatobiliary Surgery, Tongling People's Hospital, Tongling, 244000, Anhui Province, China
| | - Yafeng Hou
- Department of Hepatobiliary Surgery, Tongling People's Hospital, Tongling, 244000, Anhui Province, China.
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Yabe K, Yamagata W, Satou M, Oka I, Horike H, Namiki S, Hosoi K. Minimal endoscopic sphincterotomy followed by papillary balloon dilation to relieve choledocholithiasis in a 6-year-old girl with hereditary spherocytosis. Clin J Gastroenterol 2024:10.1007/s12328-024-01960-9. [PMID: 38517593 DOI: 10.1007/s12328-024-01960-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/17/2024] [Indexed: 03/24/2024]
Abstract
A 6-year-old girl previously diagnosed with hereditary spherocytosis was admitted to our hospital with gallstones and cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) was performed, and fluoroscopy revealed a dilated common bile duct (CBD) without evident stones, possibly due to spontaneous excretion through the papilla of Vater. A 7-French plastic stent was inserted into the CBD. After the procedure, a marked increase in pancreatic enzyme levels was observed, and she was diagnosed with post-ERCP pancreatitis (PEP). Stent placement could have been a cause of pancreatitis; therefore, we removed the stent. Subsequently, recovery from pancreatitis was confirmed, although she suddenly complained of abdominal pain and was diagnosed with choledocholithiasis recurrence. ERCP was repeated, and fluoroscopy revealed a dilated CBD with a stone. A minimal endoscopic sphincterotomy (EST) was performed to reduce the risk of PEP, and a biliary dilation balloon placed across the papilla was gradually inflated until the waist of the balloon disappeared. Stones were extracted using a retrieval balloon catheter. The abdominal pain resolved immediately, and the patient recovered without developing PEP. To our knowledge, this is the first case report of a pediatric patient treated with minimal EST followed by papillary balloon dilation for choledocholithiasis.
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Affiliation(s)
- Kiyoaki Yabe
- Department of Gastroenterology, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 183-8561, Japan.
| | - Wataru Yamagata
- Department of Gastroenterology, Tokyo Metropolitan Tama Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
| | - Masamichi Satou
- Department of Gastroenterology, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 183-8561, Japan
| | - Itsuhiro Oka
- Department of Gastroenterology, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 183-8561, Japan
| | - Hideyuki Horike
- Department of Gastroenterology, Tokyo Metropolitan Tama Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
| | - Shin Namiki
- Department of Gastroenterology, Tokyo Metropolitan Tama Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
| | - Kenji Hosoi
- Department of Gastroenterology, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 183-8561, Japan
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Guo X, Zhang J, Zhu D, Yu Y. Risk factors for the recurrence of common bile duct stones implicated in the construction of a predictive nomogram. Asian J Surg 2024; 47:1662-1664. [PMID: 38169163 DOI: 10.1016/j.asjsur.2023.12.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
- Xinyi Guo
- Department of Biliopancreatic Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Wuhan, China
| | - Jingzhao Zhang
- Department of Biliopancreatic Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Wuhan, China
| | - Dengsheng Zhu
- Department of Biliopancreatic Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Wuhan, China
| | - Yahong Yu
- Department of Biliopancreatic Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Wuhan, China.
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Singh AK, Sachdeva S, Chittem R, Dalal A. Role of Biliary Stenting After Stone Clearance in Patients Awaiting Cholecystectomy: The Jury Is Still Out! Am J Gastroenterol 2024; 119:588. [PMID: 38372294 DOI: 10.14309/ajg.0000000000002587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Affiliation(s)
- Alok Kumar Singh
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
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Le LV, Vu QV, Le TV, Le HT, Dang KK, Vu TN, Nguyen AHN, Tran TM. Outcomes of laparoscopic choledochotomy using cholangioscopy via percutaneous-choledochal tube for the treatment of hepatolithiasis and choledocholithiasis: A preliminary Vietnamese study. Ann Hepatobiliary Pancreat Surg 2024; 28:42-47. [PMID: 38114078 PMCID: PMC10896692 DOI: 10.14701/ahbps.23-085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/13/2023] [Accepted: 08/16/2023] [Indexed: 12/21/2023] Open
Abstract
Backgrounds/Aims Hepatolithiasis and choledocholithiasis are frequent pathologies and unfortunately, with the current treatment strategies, the recurrence incidence is still high. This study aimed to assess the outcomes of laparoscopic choledochotomy using cholangioscopy via the percutaneous-choledochal tube for the treatment of hepatolithiasis and choledocholithiasis in Vietnamese patients. Methods A cross-sectional study of patients with hepatolithiasis and/or choledocholithiasis who underwent laparoscopic choledochotomy using intraoperative cholangioscopy via percutaneous-choledochal tube at the Department of Hepatopancreatobiliary Surgery, 108 Military Central Hospital, from June 2017 to March 2020. Results A total of 84 patients were analyzed. Most patients were females (56.0%) with a median age of 55.56 years. Among them, 41.8% of patients had previous abdominal operations, with 33.4% having choledochotomy. All patients underwent successful laparoscopic common bile duct exploration followed by T-tube drainage without needing to convert to open surgery. Most patients (64.3%) had both intrahepatic and extrahepatic stones. The rate of stones ≥ 10 mm in diameter was 64.3%. Biliary strictures were observed in 19.1% of patients during cholangioscopy. Complete removal of stones was achieved in 54.8% of patients. Intraoperative complications were encountered in two patients, but there was no need to change the strategy. The mean operating time was 121.85 ± 30.47 minutes. The early postoperative complication rate was 9.6%, and all patients were managed conservatively. The residual stones were removed through the T-tube tract by subsequent choledochoscopy in 34/38 patients, so the total success rate was 95.2%. Conclusions Laparoscopic choledochotomy combined with cholangioscopy through the percutaneous-choledochal tube is a safe and effective strategy for hepatolithiasis and/or choledocholithiasis, even in patients with a previous choledochotomy.
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Affiliation(s)
- Loi Van Le
- Department of Hepatopancreatobiliary Surgery, Institute of Digestive Surgery, 108 Military Central Hospital, Hanoi, Vietnam
| | - Quang Van Vu
- Department of Hepatopancreatobiliary Surgery, Institute of Digestive Surgery, 108 Military Central Hospital, Hanoi, Vietnam
| | - Thanh Van Le
- Department of Hepatopancreatobiliary Surgery, Institute of Digestive Surgery, 108 Military Central Hospital, Hanoi, Vietnam
| | - Hieu Trung Le
- Department of Hepatopancreatobiliary Surgery, Institute of Digestive Surgery, 108 Military Central Hospital, Hanoi, Vietnam
| | - Khue Kim Dang
- College of Health Sciences, VinUniversity, Hanoi, Vietnam
| | - Tuan Ngoc Vu
- Department of Hepatopancreatobiliary Surgery, Institute of Digestive Surgery, 108 Military Central Hospital, Hanoi, Vietnam
| | - Anh Hoang Ngoc Nguyen
- Department of Hepatopancreatobiliary Surgery, Institute of Digestive Surgery, 108 Military Central Hospital, Hanoi, Vietnam
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Yuan WH, Zhang Z, Pan Q, Mao BN, Yuan T. Risk factors for recurrence of common bile duct stones after surgical treatment and effect of ursodeoxycholic acid intervention. World J Gastrointest Surg 2024; 16:103-112. [PMID: 38328330 PMCID: PMC10845285 DOI: 10.4240/wjgs.v16.i1.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/29/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is an accurate diagnostic method for choledocholithiasis and treatment option for stone removal. Additionally, ursodeoxycholic acid (UDCA) can dissolve cholesterol stones and prevent their development and reappearance by lowering the cholesterol concentration in bile. Despite these treatment options, there are still patients who experience stone recurrence. AIM To analyze the risk factors for choledocholithiasis recurrence after ERCP retrograde cholangiopancreatography and the effect of UDCA intervention. METHODS The clinical data of 100 patients with choledochal stones who were hospitalized at the Yixing People's Hospital and underwent ERCP for successful stone extraction between June 2020 and December 2022 were retrospectively collected. According to the post-ERCP treatment plan, 100 patients were classified into UDCA (n = 47) and control (n = 53) groups. We aimed to assess the clinical efficacy and rate of relapse in the two patient populations. We then collected information (basic demographic data, clinical characteristics, and serum biochemical indicators) and determined the factors contributing to relapse using logistic regression analysis. Our secondary goal was to determine the effects of UDCA on liver function after ERCP. RESULTS Compared to the control group, the UDCA group demonstrated a higher clinical effectiveness rate of 92.45% vs 78.72% (P < 0.05). No significant differences were observed in liver function indices, including total bilirubin, direct bilirubin, gamma-glutamyl transpeptidase, alanine aminotransferase, alkaline phosphatase, and aspartate aminotransferase, between the two groups before treatment. After treatment, all liver function indices were significantly reduced. Comparing the control vs UDCA groups, the UDCA group exhibited significantly lower levels of all indices (55.39 ± 6.53 vs 77.31 ± 8.52, 32.10 ± 4.62 vs 45.39 ± 5.69, 142.32 ± 14.21 vs 189.63 ± 16.87, 112.52 ± 14.25 vs 149.36 ± 15.36, 122.61 ± 16.00 vs 171.33 ± 22.09, 96.98 ± 10.44 vs 121.35 ± 11.57, respectively, all P < 0.05). The stone recurrence rate was lower in the UDCA group (13.21%) in contrast with the control group (44.68%). Periampullary diverticula (OR: 6.00, 95%CI: 1.69-21.30), maximum stone diameter (OR: 1.69, 95%CI: 1.01-2.85), stone quantity >3 (OR: 4.23, 95%CI: 1.17-15.26), and positive bile culture (OR: 7.61, 95%CI: 2.07-27.91) were independent factors that influenced the relapse of common bile duct stones after ERCP (P < 0.05). Furthermore, postoperative UDCA was identified as a preventive factor (OR: 0.07; 95%CI: 0.08-0.09). CONCLUSION The intervention effect of UDCA after ERCP for common bile duct stones is adequate, providing new research directions and references for the prevention and treatment of stone recurrence.
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Affiliation(s)
- Wei-Hong Yuan
- Department of Gastroenterology, Yixing People’s Hospital, Yixing 214200, Jiangsu Province, China
| | - Zheng Zhang
- Department of Gastroenterology, Yixing People’s Hospital, Yixing 214200, Jiangsu Province, China
| | - Qi Pan
- Department of Gastroenterology, Yixing People’s Hospital, Yixing 214200, Jiangsu Province, China
| | - Bo-Neng Mao
- Department of Gastroenterology, Yixing People’s Hospital, Yixing 214200, Jiangsu Province, China
| | - Tao Yuan
- Department of Gastroenterology, Yixing People’s Hospital, Yixing 214200, Jiangsu Province, China
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Pan D, Wang J, Ye H, Qin Y, Xu S, Ye G, Shen H. Tauroursodeoxycholic acid suppresses biliary epithelial cell apoptosis and endoplasmic reticulum stress by miR-107/NCK1 axis in a FXR-dependent manner. Drug Chem Toxicol 2024:1-9. [PMID: 38192027 DOI: 10.1080/01480545.2024.2301947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/03/2023] [Indexed: 01/10/2024]
Abstract
Tauroursodeoxycholic acid (TUDCA) can activate farnesoid X receptor (FXR) to involve in the formation of gallstones. Here, this study aimed to probe the potential mechanism of TUDCA-FXR network in the formation of bile duct stone. The levels of TUDCA, FXR and NCK1 were decreased, while the level of miR-107 was increased in the serum of bile duct stone patients. FXR expression was positively correlated with TUDCA or NCK1 expression in patients, moreover, TUDCA pretreatment in biliary epithelial cells increased the levels of FXR and NCK1, and rescued the decrease of NCK1 caused by FXR knockdown in cells. Then functional analysis showed FXR knockdown caused apoptosis and endoplasmic reticulum stress (ERS) as well as suppressed proliferation in biliary epithelial cells in vitro, which were attenuated by TUDCA pretreatment or NCK1 overexpression Mechanistically, NCK1 was a target of miR-107, which was up-regulated by FXR silencing, and FXR knockdown-induced decrease of NCK1 was rescued by miR-107 inhibition. Additionally, miR-107 expression was negatively correlated with TUDCA expression in bile duct stone patients, and TUDCA pretreatment in biliary epithelial cells decreased miR-107 expression by FXR. Functionally, the pretreatment of TUDCA or FXR agonist suppressed miR-107-evoked apoptosis and ERS in biliary epithelial cells. In conclusion, TUDCA up-regulates FXR expression to activate NCK1 through absorbing miR-107, thus suppressing the apoptosis and ERS in biliary epithelial cells, these results provided a theoretical basis for elucidating the mechanism of bile duct stone formation.
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Affiliation(s)
- Debiao Pan
- Department of Hepatobiliary Surgery, The Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, Lishui City, China
| | - Jun Wang
- Department of Hepatobiliary Surgery, The Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, Lishui City, China
| | - Hailin Ye
- Department of Hepatobiliary Surgery, The Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, Lishui City, China
| | - Yong Qin
- Department of Hepatobiliary Surgery, The Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, Lishui City, China
| | - Shengqian Xu
- Department of Hepatobiliary Surgery, The Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, Lishui City, China
| | - Guanxiong Ye
- Department of Hepatobiliary Surgery, The Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, Lishui City, China
| | - Hejuan Shen
- Department of Hepatobiliary Surgery, The Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, Lishui City, China
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Gao Z, Ye D, Hong X, Zhang S, He K, Lin Y, Chen X, Lu W. Ultrasound-Guided Percutaneous Transhepatic Cholangioscopic Lithotripsy for the Treatment of Common Bile Duct Stones and Analysis of Risk Factors for Recurrence. World J Surg 2023; 47:3338-3347. [PMID: 37819617 DOI: 10.1007/s00268-023-07217-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND As a minimally invasive treatment for common bile duct (CBD) stones, ultrasound-guided percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) is gaining attention and recognition from the medical community. METHODS A retrospective analysis was conducted on patients with CBD stones treated in our hospital from January 2016 to April 2022. Patients were divided into three groups: 77 treated with PTCSL, 93 with endoscopic retrograde cholangiopancreatography (ERCP), and 103 with laparoscopic common bile duct exploration (LCBDE). Their clinical data, perioperative indicators, and complications were analyzed comparatively. Then, risk factors for the post-PTCSL recurrence of CBD stones were analyzed by logistic regressions. Finally, the receiver operating characteristic curve was drawn. RESULTS All perioperative indicators of the PTCSL group were better than the LCBDE group (P < 0.001). The incidences of cholangitis, hemobilia, and incisional infection after surgery were lower in the PTCSL group than in the LCBDE group (P < 0.05). Pancreatitis, reflux esophagitis, and papillary stenosis occurred less frequently in the PTCSL group than in the ERCP group (P < 0.05). Logistic regression analysis indicated that gallstones and family history were independent risk factors. The AUC for recurrent CBD stones predicted by multi-indicators was 0.895 (95% CI 0.792-0.999, P < 0.001) with a sensitivity of 96.7% and specificity of 68.8%. CONCLUSIONS Ultrasound-guided PTCSL is a safe and effective treatment for CBD stones. Patients recovered quickly with fewer postoperative complications. It can be a first-line treatment for CBD stones. Gallstones and family history are independent risk factors for recurrent CBD stones, which provide a reference for clinicians in identifying the high-risk population needing close follow-up.
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Affiliation(s)
- Ziqing Gao
- Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-Sen University, Meihua Dong Road, No. 52, Zhuhai, 519000, Guangdong, China
| | - Dalin Ye
- Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-Sen University, Meihua Dong Road, No. 52, Zhuhai, 519000, Guangdong, China
| | - Xiaopeng Hong
- Department of Hepatobiliary Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, Meihua Dong Road, No. 52, Zhuhai, 519000, Guangdong, China
| | - Shushan Zhang
- Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-Sen University, Meihua Dong Road, No. 52, Zhuhai, 519000, Guangdong, China
| | - Kunyan He
- Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-Sen University, Meihua Dong Road, No. 52, Zhuhai, 519000, Guangdong, China
| | - Yuhong Lin
- Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-Sen University, Meihua Dong Road, No. 52, Zhuhai, 519000, Guangdong, China
| | - Xiaobo Chen
- Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-Sen University, Meihua Dong Road, No. 52, Zhuhai, 519000, Guangdong, China
| | - Wuzhu Lu
- Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-Sen University, Meihua Dong Road, No. 52, Zhuhai, 519000, Guangdong, China.
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Bergeron E, Doyon T, Manière T, Désilets É. Delay for cholecystectomy after common bile duct clearance with ERCP is just running after recurrent biliary event. Surg Endosc 2023; 37:9546-9555. [PMID: 37726412 PMCID: PMC10709473 DOI: 10.1007/s00464-023-10423-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Gallstone disease will affect 15% of the adult population with concomitant common bile duct stone (CBDS) occurring in up to 30%. Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay of management for removal of CBDS, as cholecystectomy for the prevention of recurrent biliary event (RBE). RBE occurs in up to 47% if cholecystectomy is not done. The goal of this study was to evaluate the timing of occurrence of RBE after common bile duct clearance with ERCP and associated outcomes. METHODS The records of all patients who underwent ERCP for gallstone disease followed by cholecystectomy, in a single center from 2010 to 2022, were reviewed. All RBE were identified. Actuarial incidence of RBE was built. Patients with and without RBE were compared. RESULTS The study population is composed of 529 patients. Mean age was 58.0 (18-95). There were 221 RBE in 151 patients (28.5%), 39/151 (25.8%) having more than one episode. The most frequent RBE was acute cholecystitis (n = 104) followed by recurrent CBDS (n = 95). Median time for first RBE was 34 days. Actuarial incidence of RBE started from 2.5% at 7 days to reach 53.3% at 1 year. Incidence-rate of RBE was 2.9 per 100 person-months. Patients with RBE had significant longer hospitalisation time (11.7 vs 6.4 days; P < 0.0001), longer operative time (66 vs 48 min; P < 0.0001), longer postoperative stay (2.9 vs 0.9 days; P < 0.0001), higher open surgery rate (7.9% vs 1.3%; P < 0.0001), and more complicated pathology (23.8% vs 5.8%; P < 0.0001) and cholecystitis (64.2% vs 25.9%; P < 0.0001) as final diagnoses. CONCLUSIONS RBE occurred in 28.5% of the subjects at a median time of 34 days, with an incidence of 2.5% as early as 1 week. Cholecystectomy should be done preferably within 7 days after common bile duct clearance in order to prevent RBE and adverse outcomes.
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Affiliation(s)
- Eric Bergeron
- Department of Surgery, Charles-LeMoyne Hospital, 3120, Boulevard Taschereau, Greenfield Park, QC, J4V 2H1, Canada.
| | - Théo Doyon
- Department of Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, QC, Canada
| | - Thibaut Manière
- Department of Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, QC, Canada
| | - Étienne Désilets
- Department of Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, QC, Canada
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13
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Wu Y, Zhang Y, Jiang XM, Xu CJ, Wang YY, Gu JY, Li Y, Xu SF. Risk Factors for Single and Multiple Recurrences for Endoscopic Retrograde Cholangiopancreatography and Open Choledochotomy in Treating Choledocholithiasis. Gastroenterol Res Pract 2023; 2023:4738985. [PMID: 37941974 PMCID: PMC10630008 DOI: 10.1155/2023/4738985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 06/29/2023] [Accepted: 10/14/2023] [Indexed: 11/10/2023] Open
Abstract
Background There are few studies comparing recurrences between endoscopic retrograde cholangiopancreatography (ERCP) and open choledochotomy (OCT). Aims To compare the effect of different surgical methods on single and multiple recurrences of choledocholithiasis. Methods A total of 1255 patients with choledocholithiasis who underwent ERCP or OCT were retrospectively studied. The recurrence of choledocholithiasis was calculated by the Kaplan-Meier method with the log-rank test. Multivariate analyses of recurrent choledocholithiasis were performed by introducing variables with P < 0.20 in univariate analysis into the logistic regression model. Results A total of 204 (16.7%, 204/1225) patients relapsed. Among the 204 patients, 74.5% relapsed within three years after surgery, of whom 39.7% (81/204) had multiple relapses (≥ 2). The recurrence rate of ERCP (17.2%, 119/692) was higher than that of OCT (15.1%, 85/563), but the difference was not statistically significant. The independent risk factors for a single recurrence of choledocholithiasis were diabetes, stone number ≥ 2, maximum stone diameter ≥ 15 mm, sedentary occupation, the approach of ERCP (EST or EPBD), periampullary diverticulum, primary suture, high-fat diet (postoperative), frequency of weekly vegetable intake (< 4, postoperative), and drinking (postoperative). However, the ERCP approach (EST or EPBD), OCT approach (LCBDE), primary suture, high-fat diet (postoperative), and frequency of weekly vegetable intake (< 4, postoperative) were independent risk factors for multiple recurrences of choledocholithiasis. Conclusion Patients with choledocholithiasis should be followed up regularly for one to three years after treatment. Stone number ≥ 2, diabetes mellitus, periampullary diverticulum, surgical methods, and lifestyle are all risk factors for the recurrence of choledocholithiasis. ERCP is still the preferred surgical method based on the advantages of low risk of cholangitis recurrence, less hospital stay, minimally invasive surgery, fewer postoperative complications, and easier acceptance by elderly patients. In addition to optimizing the treatment plans, postoperative lifestyle management is also vital.
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Affiliation(s)
- Yao Wu
- Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, China
| | - Ying Zhang
- School of Public Health, Southeast University, Nanjing 211189, China
| | - Xiao Meng Jiang
- Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, China
| | - Chen Jing Xu
- Jiangsu Province Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Yan Yan Wang
- Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, China
| | - Jin Yuan Gu
- Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, China
| | - Yi Li
- Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, China
| | - Shun Fu Xu
- Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, China
- Jiangsu Province Hospital, Nanjing Medical University, Nanjing 210029, China
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14
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Wang H, He YQ, Dong SY, Zhong W, Tao P, Yang SY, Liu ZJ. Recurrence of common bile duct stones after choledocholithotomy in elderly patients: risk factor analysis and clinical prediction model development. Front Med (Lausanne) 2023; 10:1239902. [PMID: 37937139 PMCID: PMC10626465 DOI: 10.3389/fmed.2023.1239902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/11/2023] [Indexed: 11/09/2023] Open
Abstract
Background The reasons for the recurrence of common bile duct stones (CBDS) in elderly patients after choledocholithotomy are still unclear. This study aims to establish a prediction model for CBDS recurrence by identifying risk factors. Methods We conducted a retrospective analysis of 1804 elderly patients aged 65 years and above who were diagnosed to have CBDS and were admitted to Nanjing First Hospital between January 1, 2010, and January 1, 2021. According to inclusion and exclusion criteria, 706 patients were selected for the final analysis. The patients were assigned to two groups according to the presence or absence of CBDS recurrence, and their clinical data were then statistically analyzed. Subsequently, a prediction model and nomogram were developed, evaluating effectiveness using the concordance index (C-index). Results Of the 706 elderly patients, 62 patients experienced CBDS recurrence after surgery, resulting in a recurrence rate of 8.8%. The multivariate Cox analysis showed that prior history of cholecystectomy (hazard ratio [HR] = 1.931, 95% confidence interval [CI]: 1.051-3.547, p = 0.034), white blood cell (WBC) count ≥11.0 × 109/L (HR = 2.923, 95% CI: 1.723-4.957, p < 0.001), preoperative total bilirubin (TBIL) level ≥ 36.5 mmol/L (HR = 2.172, 95% CI: 1.296-3.639, p = 0.003), number of stones ≥2 (HR = 2.093, 95% CI: 1.592-5.294, p = 0.001), maximum stone diameter ≥ 0.85 cm (HR = 1.940, 95% CI: 1.090-3.452, p = 0.024), and T-tube drainage (HR = 2.718, 95% CI: 1.230-6.010, p = 0.013) were independent risk factors of CBDS recurrence in elderly patients after choledocholithotomy. A postoperative CBDS recurrence prediction model was constructed with a C-index value of 0.758 (95% CI: 0.698-0.818) and internal validation value of 0.758 (95% CI: 0.641-0.875). Conclusion A history of cholecystectomy, WBC count ≥11.0 × 109/L, preoperative TBIL level ≥ 36.5 mmol/L, number of stones ≥2, maximum stone diameter ≥ 0.85 cm, and T-tube drainage are the independent risk factors of CBDS recurrence after choledocholithotomy in elderly patients. Our developed prediction model for CBDS recurrence has good predictive ability and can help predict the prognosis of patients with CBDS.
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Affiliation(s)
| | | | | | | | | | | | - Zi-jun Liu
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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15
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Lu X, Wang Y, Liu W, Zhang Y, Zheng W, Yan X, Chang H, Huang Y. Endoclip papillaplasty (ECPP) versus limited EST plus EPLBD for a decrease in recurrent choledocholithiasis: a prospective cohort study. Surg Endosc 2023; 37:7790-7802. [PMID: 37592046 DOI: 10.1007/s00464-023-10326-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/19/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND AND AIMS Limited EST plus EPLBD has been widely used for the therapy of large CBDS; however, long-term complication-relevant studies suggested that it damaged the function of the sphincter of Oddi (SO) and resulted in recurrent choledocholithiasis. Thus, we designed Endoclip papillaplasty (ECPP) and previous studies have shown that it successfully restored the function of SO. In this study, we designed a prospective cohort and aimed to verify the safety and effectiveness of ECPP. METHODS Eligible patients were divided into the ECPP group and the limited EST plus EPLBD group based on papillary morphology and the ratio of maximum size of stones to length of intramural segments of CBD. All participants in the ECPP group received endoscopy at 3 weeks to retrieve the biliary stent, perform SOM, and were divided into grade A and grade B based on the healing grade of SO. All patients were followed up every 6 months until recurrent choledocholithiasis, patient death, or at the 36-month follow-up end. The primary outcome was the incidence of recurrent choledocholithiasis. The secondary outcomes included mechanical lithotrip usage and adverse events. RESULTS The incidences of recurrent choledocholithiasis in the ECPP group and limited EST plus EPLBD group were 13.6 and 22.1%, respectively (P = 0.204). The ECPP-A group had a lower incidence of recurrent choledocholithiasis than the limited EST plus EPLBD groups (5.1 vs. 22.1%, P = 0.020*), and certified the function of SO successfully restored in the ECPP-A group. CONCLUSION The ECPP-A group had a decrease in recurrent choledocholithiasis, and ECPP was safe and effective for CBDS.
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Affiliation(s)
- Xiaofang Lu
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China
| | - Yingchun Wang
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China
| | - Wenzheng Liu
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China
| | - Yaopeng Zhang
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China
| | - Wei Zheng
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China
| | - Xiue Yan
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China.
| | - Hong Chang
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China.
| | - Yonghui Huang
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China.
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Sasani A, Mandavdhare HS, Sharma V, Shah J, Patil A, Gupta P, Samanta J, Singh H, Dutta U. Role of Biliary Stent in Recurrence of Biliary Stones and Complications After Stone Clearance in Patients Awaiting Cholecystectomy: A Randomized Trial. Am J Gastroenterol 2023; 118:1864-1870. [PMID: 37561074 DOI: 10.14309/ajg.0000000000002471] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION The role of prophylactic biliary stenting after clearance of choledocholithiasis in patients awaiting cholecystectomy for concomitant cholelithiasis is controversial. We planned a randomized controlled trial to study the effect of prophylactic biliary stenting after achieving biliary clearance in reducing recurrence of choledocholithiasis and biliary complications in patients awaiting cholecystectomy. METHODS Patients with concomitant cholelithiasis and choledocholithiasis were included, and those who had evidence of clearance of choledocholithaisis (documented on occlusion cholangiogram during endoscopic retrograde cholangiography [ERC]) were randomized to prophylactic biliary stenting or no stenting. Choledocholithaisis recurrence rate (primary outcome), biliary complications and need for repeat/emergency ERC (secondary outcomes) were compared till 3 months after clearance. RESULTS Between September 2021 and July 2022, 70 patients were randomized into group A, stenting (n = 35), and group B, no stenting (n = 35). Sixty-six patients were included in the final analysis. Baseline characteristics were comparable between the 2 groups. Ten (15.2%) patients had recurrence of choledocholithiasis, and it was comparable between the 2 groups (7/34 [20.6%] and 3/34 [9.4%], P = 0.306). Five patients (2 cholecystitis and 3 post-ERC pancreatitis) from the stent group while none from the no stent group developed complications, and this difference was statistically significant ( P = 0.024). None of the patients in both the groups needed emergency ERC during the follow-up. DISCUSSION This randomized trial shows a higher complication rate with prophylactic stenting, while there is no benefit in preventing choledocholithiasis recurrence in patients waiting for cholecystectomy after biliary clearance (CTRI registration number: CTRI/2021/09/036538).
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Affiliation(s)
- Arpit Sasani
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harshal S Mandavdhare
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jimil Shah
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amol Patil
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harjeet Singh
- Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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17
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Bergeron E, Doyon T, Manière T, Désilets É. Cholecystectomy following endoscopic clearance of common bile duct during the same admission. Can J Surg 2023; 66:E477-E484. [PMID: 37734850 PMCID: PMC10521812 DOI: 10.1503/cjs.008322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The recurrence of common bile duct stones and other biliary events after endoscopic retrograde cholangiopancreatography (ERCP) is frequent. Despite recommendations for early cholecystectomy, intervention during the same admission is carried out inconsistently. METHODS We reviewed the records of patients who underwent ERCP for gallstone disease and common bile duct clearance followed by cholecystectomy between July 2012 and June 2022. Patients were divided into 2 groups: the index group underwent cholecystectomy during the same admission and the delayed group was discharged and had their cholecystectomy postponed. Data on demographics and prognosis factors were collected and analyzed. RESULTS The study population was composed of 268 patients, with 71 (26.6%) having undergone cholecystectomy during the same admission after common bile duct clearance with ERCP. A greater proportion of patients aged 80 years and older were in the index group than in the delayed group. The American Society of Anesthesiologists score was significantly higher in the index group. There was no significant difference between groups regarding surgical complications, open cholecystectomy and death. The operative time was significantly longer in the delayed group. Among patients with delayed cholecystectomy, 18.3% had at least 1 recurrence of common bile duct stones (CBDS) and 38.6% had recurrence of any gallstone-related events before cholecystectomy. None of these events occurred in the the index group. There was no difference in the recurrence of CBDS and other biliary events after initial diagnosis associated with stone disease. CONCLUSION Cholecystectomy during the same admission after common bile duct clearance is safe, even in older adults with comorbidities. Compared with delayed cholecystectomy, it was not associated with adverse outcomes and may have prevented recurrence of biliary events.
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Affiliation(s)
- Eric Bergeron
- Department of Surgery, Hôpital Charles LeMoyne, Greenfield Park, Que. (Bergeron); Department of Gastroenterology, Hôpital Charles LeMoyne, Greenfield Park, Que. (Doyon, Maniere, Desilets)
| | - Théo Doyon
- Department of Surgery, Hôpital Charles LeMoyne, Greenfield Park, Que. (Bergeron); Department of Gastroenterology, Hôpital Charles LeMoyne, Greenfield Park, Que. (Doyon, Maniere, Desilets)
| | - Thibaut Manière
- Department of Surgery, Hôpital Charles LeMoyne, Greenfield Park, Que. (Bergeron); Department of Gastroenterology, Hôpital Charles LeMoyne, Greenfield Park, Que. (Doyon, Maniere, Desilets)
| | - Étienne Désilets
- Department of Surgery, Hôpital Charles LeMoyne, Greenfield Park, Que. (Bergeron); Department of Gastroenterology, Hôpital Charles LeMoyne, Greenfield Park, Que. (Doyon, Maniere, Desilets)
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18
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Fan L, Wang Y, Wu M, Wu T, Deng L, Wang Y, Liu L, An T. Laparoscopic common bile duct exploration with primary closure could be safely performed among elderly patients with choledocholithiasis. BMC Geriatr 2023; 23:486. [PMID: 37568121 PMCID: PMC10416467 DOI: 10.1186/s12877-023-04149-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 07/03/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND For patients with choledocholithiasis, laparoscopic common bile duct exploration (LCBDE) is preferred over open surgery. Whether primary closure of the common bile duct (CBD) should be performed upon completion of choledochotomy remains unclear, and the corresponding indications for primary closure of the common bile duct have yet to be fully identified. This study was performed to evaluate the safety and feasibility of primary closure of CBD among elderly patients (≥ 70 years) after LCBDE. METHODS Patients with choledocholithiasis who had undergone LCBDE with primary closure of the CBD between July 2014 and December 2020 were retrospectively reviewed. Included patients were assigned into two groups (Group A: ≥70 years and Group B: <70 years) according to age. Group A was compared with Group B in terms of preoperative characteristics, intraoperative results and postoperative outcomes. RESULTS The mean operative time for Group A was 176.59 min (± 68.950), while the mean operative time for Group B was 167.64 min (± 69.635) (P = 0.324). The mean hospital stay after surgery for Group A was 8.43 days (± 4.440), while that for Group B was 8.30 days (± 5.203) (P = 0.849). Three patients in Group A experienced bile leakage, while bile leakage occurred in 10 patients in Group B (3.8% vs. 4.5%, P = 0.781). Group A was not significantly different from Group B in terms of postoperative complications and 30-day mortality except pneumonia (P = 0.016), acute cardiovascular event (P = 0.005) and ICU observation (P = 0.037). After a median follow-up time of 60 months, 2 patients in Group A and 2 patients in Group B experienced stone recurrence (2.5% vs. 0.9%, P = 0.612). One patient in Group A experienced stenosis of the CBD, while stenosis of the CBD occurred in 5 patients in Group B (1.3% vs. 2.2%, P = 0.937). CONCLUSIONS Primary closure of CBD upon completion of LCBDE could be safely performed among patients ≥ 70 years.
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Affiliation(s)
- Lili Fan
- Department of Geriatric Medicine, Shenzhen Traditional Chinese Medicine Hospital, Fuhua Road 1, Futian District, Shenzhen, 518033, Guangdong, China
| | - Yan Wang
- Department of Radiology, Shenzhen People's Hospital, Dongmen Road 1017, Luohu District, Shenzhen, 518020, Guangdong, China
| | - Meilong Wu
- Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital, Dongmen Road 1017, Luohu District, Shenzhen, 518020, Guangdong, China
| | - Tianchong Wu
- Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital, Dongmen Road 1017, Luohu District, Shenzhen, 518020, Guangdong, China
| | - Lingna Deng
- Department of Pathology, Qingyuan People's Hospital, Yinquan Road B24, Qingcheng District, Qingyuan, 511518, Guangdong, China
| | - Yawei Wang
- The First Department of Surgery, Shenzhen Traditional Chinese Medicine Hospital, Fuhua Road 1, Futian District, Shenzhen, 518033, Guangdong, China
| | - Linsen Liu
- Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital, Dongmen Road 1017, Luohu District, Shenzhen, 518020, Guangdong, China.
| | - Tailai An
- Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital, Dongmen Road 1017, Luohu District, Shenzhen, 518020, Guangdong, China.
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Shi Y, Lin J, Zhu J, Gao J, Liu L, Yin M, Yu C, Liu X, Wang Y, Xu C. Predicting the Recurrence of Common Bile Duct Stones After ERCP Treatment with Automated Machine Learning Algorithms. Dig Dis Sci 2023:10.1007/s10620-023-07949-7. [PMID: 37160541 DOI: 10.1007/s10620-023-07949-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/26/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Recurrence of common bile duct stones (CBDs) commonly happens after endoscopic retrograde cholangiopancreatography (ERCP). The clinical prediction models for the recurrence of CBDs after ERCP are lacking. AIMS We aim to develop high-performance prediction models for the recurrence of CBDS after ERCP treatment using automated machine learning (AutoML) and to assess the AutoML models versus the traditional regression models. METHODS 473 patients with CBDs undergoing ERCP were recruited in the single-center retrospective cohort study. Samples were divided into Training Set (65%) and Validation Set (35%) randomly. Three modeling approaches, including fully automated machine learning (Fully automated), semi-automated machine learning (Semi-automated), and traditional regression were applied to fit prediction models. Models' discrimination, calibration, and clinical benefits were examined. The Shapley additive explanations (SHAP), partial dependence plot (PDP), and SHAP local explanation (SHAPLE) were proposed for the interpretation of the best model. RESULTS The area under roc curve (AUROC) of semi-automated gradient boost machine (GBM) model was 0.749 in Validation Set, better than the other fully/semi-automated models and the traditional regression models (highest AUROC = 0.736). The calibration and clinical application of AutoML models were adequate. Through the SHAP-PDP-SHAPLE pipeline, the roles of key variables of the semi-automated GBM model were visualized. Lastly, the best model was deployed online for clinical practitioners. CONCLUSION The GBM model based on semi-AutoML is an optimal model to predict the recurrence of CBDs after ERCP treatment. In comparison with traditional regressions, AutoML algorithms present significant strengths in modeling, which show promise in future clinical practices.
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Affiliation(s)
- Yuqi Shi
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
- Suzhou Clinical Center of Digestive Diseases, Suzhou, 215000, China
| | - Jiaxi Lin
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
- Suzhou Clinical Center of Digestive Diseases, Suzhou, 215000, China
| | - Jinzhou Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
- Suzhou Clinical Center of Digestive Diseases, Suzhou, 215000, China
| | - Jingwen Gao
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
- Suzhou Clinical Center of Digestive Diseases, Suzhou, 215000, China
| | - Lu Liu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
- Suzhou Clinical Center of Digestive Diseases, Suzhou, 215000, China
| | - Minyue Yin
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
- Suzhou Clinical Center of Digestive Diseases, Suzhou, 215000, China
| | - Chenyan Yu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
- Suzhou Clinical Center of Digestive Diseases, Suzhou, 215000, China
| | - Xiaolin Liu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
- Suzhou Clinical Center of Digestive Diseases, Suzhou, 215000, China
| | - Yu Wang
- Department of General Surgery, Jintan Affiliated Hospital of Jiangsu University, Changzhou, 213200, China
| | - Chunfang Xu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China.
- Suzhou Clinical Center of Digestive Diseases, Suzhou, 215000, China.
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20
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Lin Y, Yang M, Cao J, Zhang X, Mi N, Yang X, Wang H, Gao L, Bai M, Fu W, Li X, Yue P, Yuan J, Meng W, Leung JW. Saline irrigation for reducing the recurrence of common bile duct stones after lithotripsy: a randomized controlled trial. EClinicalMedicine 2023; 59:101978. [PMID: 37152367 PMCID: PMC10154959 DOI: 10.1016/j.eclinm.2023.101978] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 05/09/2023] Open
Abstract
Background Mechanical lithotripsy produces stone fragments that are not easily detected by cholangiography and is a potential cause of recurrence of common bile duct stones (CBDS). This study aims to clarify whether 100 ml saline irrigation after mechanical lithotripsy reduces the recurrent rate of CBDS. Methods In this randomized controlled trial performed at the Surgical Endoscopy Center, the First Hospital of Lanzhou University between May 10, 2019, and Dec 31, 2020, patients undergoing endoscopic mechanical lithotripsy were randomly assigned to receive saline irrigation (study group) or no irrigation (control group). The saline irrigation was given 100 ml saline pulse irrigation after cholangiography showed no residual stones. Patients were followed up for at least 24 months after endoscopic stone removal to assess the recurrence of CBDS. This study was registered with ClinicalTrials.gov (NCT03937037). Findings During the median follow-up period of 35.6 months (interquartile range, 26.0-40.7), 43 of the 180 patients had stone recurrence (24%). The frequency of recurrence of CBD stones was 12.22% in the saline irrigation group and 35.56% in the control group, with a difference of 23.33% between the two groups (95% confidence interval [CI], 11.35%-35.32%, p < 0.001). Multivariable Cox proportional hazards analyses showed that constipation (hazard risk [HR] 2.42; 95% CI, 1.22-4.80, p = 0.012), periampullary diverticulum (PAD) (HR 3.06; 95% CI, 1.62-5.79, p < 0.001), and total to direct bilirubin ratio (HR 1.48; 95% CI, 1.21-1.81, p < 0.001) were independent risk factors for the recurrence of CBDS. Saline irrigation was the only preventive factor for the recurrence of CBDS (HR 0.22; 95% CI, 0.11-0.44, p < 0.001). Interpretation For patients with CBDS requiring mechanical lithotripsy, 100 ml saline irrigation effectively reduces the recurrent rate of CBDS after endoscopic stone removal. Funding This work was supported by National Natural Science Foundation of China (32160255); Natural Science Foundation of Gansu Province (22JR5RA898, 20JR10RA676); Science and Technology Planning Project of Chengguan District in Lanzhou (2020JSCX0043).
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Affiliation(s)
- Yanyan Lin
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030, Gansu, China
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou, 730030, Gansu, China
| | - Man Yang
- Clinical Research Center, Big Data Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, Guangdong, China
| | - Jie Cao
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Xianzhuo Zhang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Ningning Mi
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Xiao Yang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Haiping Wang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030, Gansu, China
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou, 730030, Gansu, China
| | - Long Gao
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Mingzhen Bai
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Wenkang Fu
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Xun Li
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030, Gansu, China
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou, 730030, Gansu, China
| | - Ping Yue
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030, Gansu, China
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou, 730030, Gansu, China
- Corresponding author. The First School of Clinical Medicine, Lanzhou University. Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030, Gansu, China.
| | - Jinqiu Yuan
- Clinical Research Center, Big Data Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, Guangdong, China
- Corresponding author.
| | - Wenbo Meng
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730030, Gansu, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030, Gansu, China
- Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou, 730030, Gansu, China
- Corresponding author. The First School of Clinical Medicine, Lanzhou University. Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730030, Gansu, China.
| | - Joseph W. Leung
- Division of Gastroenterology, UC Davis Medical Center and Sacramento VA Medical Center, Sacramento, 95817, California, USA
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21
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Burckhardt O, Peisl S, Rouiller B, Colinet E, Egger B. Length of the Remnant Cystic Duct and Bile Duct Stone Recurrence: a Case‒Control Study. J Gastrointest Surg 2023:10.1007/s11605-023-05607-x. [PMID: 36859605 DOI: 10.1007/s11605-023-05607-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/21/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Since the introduction of the Critical View of Safety approach in laparoscopic cholecystectomy, exposure of the common bile duct, and common hepatic duct is not recommended, therefore, the length of the cystic duct remnant is no longer controlled. The aim of this case‒control study is to evaluate the relationship between the length of the cystic duct remnant and the risk for bile duct stone recurrence after cholecystectomy. METHODS All MRIs with dedicated sequences of the biliary tract taken between 2010 and 2020 from patients who underwent prior cholecystectomy were reviewed. The length of the cystic duct remnant was measured and compared between the patients with and without bile duct stones using multivariate logistic regression analysis. RESULTS A total of 362 patients were included in this study, 23.5% of whom had bile duct stones on MRI. The cystic duct remnant was significantly longer in the patients with stones than in the control group (median 31 mm versus 18 mm, P < 0.001). In the MRIs performed > 2 years after cholecystectomy, the cystic duct remnant was also significantly longer in the patients with bile duct stones (median 32 mm versus 21 mm, P < 0.001). A cystic duct remnant ≥ 15 mm in length increased the odds of stones (OR = 2.3, P = 0.001). Overall, the odds of bile duct stones increased with an increasing cystic duct remnant length (≥ 45 mm, OR = 5.0, P < 0.001). CONCLUSIONS An excessive cystic duct remnant length increases the odds of recurrent bile duct stones after cholecystectomy.
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Affiliation(s)
- Oliver Burckhardt
- Department of Surgery, HFR Fribourg - Cantonal Hospital, Chemin Des Pensionnats 2-6, 1752, Villars-Sur-Glâne, Switzerland
| | - Sarah Peisl
- Department of Surgery, HFR Fribourg - Cantonal Hospital, Chemin Des Pensionnats 2-6, 1752, Villars-Sur-Glâne, Switzerland
| | | | - Emilie Colinet
- Department of Radiology, HFR Fribourg - Cantonal Hospital, Villars-Sur-Glâne, Switzerland
| | - Bernhard Egger
- Department of Surgery, HFR Fribourg - Cantonal Hospital, Chemin Des Pensionnats 2-6, 1752, Villars-Sur-Glâne, Switzerland. .,University of Fribourg, Av. de l'Europe 20, 1700, Fribourg, Switzerland.
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22
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Residual choledocholithiasis after choledocholithotomy T-tube drainage: what is the best intervention strategy? BMC Gastroenterol 2022; 22:509. [PMID: 36494797 PMCID: PMC9733260 DOI: 10.1186/s12876-022-02601-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The best intervention approach for residual choledocholithiasis after choledocholithotomy T-tube drainage remains controversial, especially during the period of indwelling T tube and the formation of a sinus. The purpose of the study was to estimate the effects of two therapeutic modalities, namely endoscopic retrograde cholangiopancreatography (ERCP) and choledochfiberscope via the T-tube sinus tract (CDS) on residual choledocholithiasis after choledocholithotomy T-tube drainage. METHODS A total of 112 patients with residual choledocholithiasis after choledochotomy were included in the study, 50 of which underwent ERCP and 62 patients experienced choledochoscopy via the T-tube sinus tract. The primary outcome measures included the success rate of remove biliary stones, T-tube drainage time, and the average length of hospital stay. The secondary objective was to consider incidence of adverse events including cholangitis, bile leakage, T-tube migration, pancreatitis, bleeding and perforation. After hospital discharge, patients were followed up for two years and the recurrence of choledocholithiasis was recorded. RESULTS There was no significant difference in the success rate of stone removal between the two groups. Compared to CDS group, T-tube drainage time and the average length of hospital stay was significantly shorter in the ERCP group. The incidence of complications (cholangitis and bile leakage) in the ERCP group was lower than that in the CDS group, but there was no statistically significant difference. When the T-tube sinus tract is not maturation, ERCP was the more appropriate endoscopic intervention to remove residual choledocholithiasis, particularly complicated with cholangitis at this time period. CONCLUSIONS ERCP is a safe and effective endoscopic intervention to remove residual choledocholithiasis after choledocholithotomy T-tube Drainage without the condition of T-tube sinus tract restriction.
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Mansour S, Kluger Y, Khuri S. Primary Recurrent Common Bile Duct Stones: Timing of Surgical Intervention. J Clin Med Res 2022; 14:441-447. [PMID: 36578366 PMCID: PMC9765319 DOI: 10.14740/jocmr4826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/24/2022] [Indexed: 11/30/2022] Open
Abstract
Cholelithiasis (gallstones) is a very common medical problem worldwide, with 5-30% of patients demonstrating a combined condition of cholelithiasis and choledocholithiasis (common bile duct stones (CBDS)). CBDS are usually classified as primary or secondary stones. Primary CBDS are defined as stones detected 2 years or more following cholecystectomy, while secondary stones, the most common type, usually migrate from the gallbladder to the bile ducts. Recurrent CBDS are defined as stones detected 6 months or more following endoscopic retrograde cholangiopancreatography (ERCP) with complete duct clearance. Although ERCP with endoscopic sphincterotomy has emerged as the main therapeutic option for CBDS, with up to 95% bile duct clearance rate, up to 25% of said patients develop recurrent bile duct stones. Thus far, several issues related to recurrent CBDS are still unclear and questions regarding this specific pathology have no precise answers: how many trials of ERCP and endoscopic sphincterotomy should be attempted before referring the patient for surgical management? Is there an association between risk factors and early surgical intervention? Thus, currently, there is no worldwide scientific-based consensus regarding the best management of this specific group of patients. The main issue for this article is to review the relevant English literature and find out the main high risk factors for recurrent CBDS, and form a diagnostic and treatment plan, hence, identifying the subgroup of patients that will benefit from early surgical management, preventing further ERCP-associated complications.
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Affiliation(s)
- Subhi Mansour
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel,HPB and Surgical Oncology Unit, Rambam Health Care Campus, Haifa, Israel
| | - Safi Khuri
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel,HPB and Surgical Oncology Unit, Rambam Health Care Campus, Haifa, Israel,Corresponding Author: Safi Khuri, Department of General Surgery, Rambam Health Care Campus, Haa’leya Hashniya, Haifa 31096, Israel.
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24
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Tseimakh AE, Kurtukov VA, Mishchenko AN, Tepluhin VN, Shoikhet YN. A CLINICAL CASE OF THE ELIMINATION OF MEGACHOLEDOCHOLITHIASIS USING ANTEGRADE PERCUTANEOUS TRANSHEPATIC CONTACT ELECTROPULSE LITHOTRIPSY AND LITHOEXTRACTION. SURGICAL PRACTICE 2022. [DOI: 10.38181/2223-2427-2022-3-78-84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the article there is presented a clinical case of the elimination of megacholedocholithiasis using antegrade percutaneous transhepatic contact electro-impulse lithotripsy and lithextraction. Due to the technical impossibility of performing endoscopic retrograde lithotripsy, the patient was performed antegrade percutaneous transhepatic contact electro-impulse lithotripsy and lithextraction, which made it possible to eliminate megacholedocholithiasis without the development of postoperative complications, restore the lumen of the bile ducts and provide the possibility of subsequent planned surgical treatment of chronic calculous cholecystitis.
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Affiliation(s)
- A. E. Tseimakh
- Altai State Medical University of the Ministry of Health of the Russian Federation
| | | | | | | | - Ya. N. Shoikhet
- Altai State Medical University of the Ministry of Health of the Russian Federation
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25
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Retention Time of Endoscopic Nasobiliary Drainage and Symptomatic Choledocholithiasis Recurrence After Endoscopic Retrograde Cholangiopancreatography: A Single-center, Retrospective Study in Fuyang, China. Surg Laparosc Endosc Percutan Tech 2022; 32:481-487. [PMID: 35583568 DOI: 10.1097/sle.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Endoscopic nasobiliary drainage (ENBD) is usually retained for several days after choledocholithiasis is removed by endoscopic retrograde cholangiopancreatography (ERCP). ENBD placement provides reliable biliary drainage and perfusion, prevents pancreatitis, and allows for cholangiography. However, it has not been established whether retention time of ENBD is associated with symptomatic choledocholithiasis recurrence after ERCP. For this reason, we estimated the effect of ENBD retention time on symptomatic choledocholithiasis recurrence after ERCP. PATIENTS AND METHODS A total of 1016 patients in whom choledocholithiasis had been diagnosed and ERCP had been performed to remove choledocholithiasis were retrospectively reviewed. Their ENBD retention time was 4.01±1.53 days. They were divided into group 1 (n=570) and group 2 (n=446) according to the mean value. Cumulative recurrence rates of symptomatic choledocholithiasis after ERCP were compared between the 2 groups. To identify independent factors associated with symptomatic choledocholithiasis recurrence, various likely predictors associated with the intergroup differences were also recorded. RESULTS There were 570 patients with ENBD retention time ≤4.01 days (group 1) and 446 patients with ENBD retention time >4.01 days (group 2). No statistically significant differences between the 2 groups were evident in terms of demographic factors and laboratory results, except for amylase (AMY) and opening diet time after ERCP. The median (interquartile range) follow-up was 23.7 (14.6, 32.13) months (range: 4.3 to 70 mo) in group 1 and 23.7 (14.6, 31.2) months (range: 4.2 to 69.4 mo) in group 2 (P=0.762). The cumulative recurrence rates of symptomatic choledocholithiasis were 3.1% (2.5% vs. 3.8%) at month 20, 6.7% (5.1% vs. 8.7%) at month 40, and 8.2% (6.7% vs. 10.1%) at month 60 for groups 1 and 2, respectively (P=0.048). By multivariate analysis, being in group 1 reduced symptomatic choledocholithiasis recurrence, with a hazard ratio of 0.641 (95% confidence interval: 0.416-0.987,P=0.044). CONCLUSIONS This preliminary study showed that symptomatic choledocholithiasis recurrence may be associated with ENBD retention time after ERCP, particularly for duration of ENBD more than 4.01 days.
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Dai T, Qiu S, Qian J. Risk Factors for Recurrent Common Bile Duct Stones After Endoscopic Retrograde Cholangiopancreatography. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03400-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Akay T, Sari E. Identification of risk factors involved in recurrence after common bile duct stone removal with ERCP: A retrospective observational study. Medicine (Baltimore) 2022; 101:e29037. [PMID: 35244085 PMCID: PMC8896433 DOI: 10.1097/md.0000000000029037] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/18/2022] [Indexed: 11/25/2022] Open
Abstract
Recurrent stone detection is common after endoscopic treatment of common bile duct stones (CBDS). This study aimed to identify the risk factors for recurrence of CBDS.We retrospectively evaluated 14 patients who underwent endoscopic treatment for CBDS. Risk factors for single and multiple recurrent CBDSs were evaluated using logistic regression analysis.Endoscopic and needle-knife precut sphincterotomy was performed in 506 and 112 patients, respectively. There was 1 recurrence in 85 patients (13.8%), 2 recurrences in 23 patients (3.7%), and 3 recurrences in 9 patients (1.5%). According to the multivariate analyses, being older than 65 years (odds ratio [OR] 1.084, P = .000), concomitant heart disease (OR 2.528, P = .002), concomitant lung disease (OR 1.766, P = .035), a large common bile duct diameter (OR 1.347, P = .000), presence of cholelithiasis (OR 1.752, P = .018), stent (OR 1.794, P = .023), or T-tube placement in the common bile duct (OR 47.385, P = .000), and prolongation of the procedure (OR 1.037, P = .000) increased the risk of recurrence, while having undergone cholecystectomy due to gallstones (OR 1.645, P = .042). The mean stone diameter (P = .059), nitroglycerin use (P = .129), and periampullary diverticulum (P = .891) did not increase the risk of recurrent CBDS.The probability of multiple recurrences after the first recurrence of CBDS increased with age >65 years, concomitant heart/lung diseases, stent/T-tube placement in the common bile duct, a wide common bile duct (≥10 mm), and cholelithiasis.
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Affiliation(s)
- Tamer Akay
- Bandirma Onyedi Eylül University Faculty of Medicine, Department of General Surgery, Balikesir, Turkey
| | - Erdem Sari
- Bandirma Onyedi Eylül University Faculty of Medicine, Department of General Surgery, Balikesir, Turkey
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28
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Xie W, Yang T, Zhou X, Ma Z, Yu W, Song G, Hu Z, Gong J, Wang Y, Song Z. A nomogram for predicting stones recurrence in patients with bile duct stones undergoing laparoscopic common bile duct exploration. Ann Gastroenterol Surg 2022; 6:543-554. [PMID: 35847430 PMCID: PMC9271022 DOI: 10.1002/ags3.12550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/20/2021] [Accepted: 01/08/2022] [Indexed: 11/06/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Wangcheng Xie
- Department of General Surgery Shanghai Tenth People’s Hospital Tongji University School of Medicine Shanghai China
| | - Tingsong Yang
- Department of General Surgery Shanghai Tenth People’s Hospital Tongji University School of Medicine Shanghai China
| | - Xue Zhou
- Department of Dermatology Shanghai Tenth People's Hospital Tongji University School of Medicine Shanghai China
| | - Zhilong Ma
- Department of General Surgery Shanghai Tenth People’s Hospital Tongji University School of Medicine Shanghai China
- Department of General Surgery Tongren Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Weidi Yu
- Department of General Surgery Shanghai Tenth People’s Hospital Tongji University School of Medicine Shanghai China
| | - Guodong Song
- Department of General Surgery Shanghai Tenth People’s Hospital Tongji University School of Medicine Shanghai China
| | - Zhengyu Hu
- Department of General Surgery Shanghai Tenth People’s Hospital Tongji University School of Medicine Shanghai China
| | - Jian Gong
- Department of General Surgery Shanghai Tenth People’s Hospital Tongji University School of Medicine Shanghai China
| | - Yuxiang Wang
- Department of General Surgery Shanghai Tenth People’s Hospital Tongji University School of Medicine Shanghai China
| | - Zhenshun Song
- Department of General Surgery Shanghai Tenth People’s Hospital Tongji University School of Medicine Shanghai China
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