Small Endoscopic Biliary Sphincterotomy Facilitates Long-Term Recurrence Of Common Bile Duct Stones

Common bile duct (CBD) stones occur in 10% to 15% of patients with CBD disease. However, there has been no consensus achieved on the treatment of CBD stones to date. The current study aimed to assess the effect of endoscopic biliary sphincterotomy (EST) on the long-term recurrence of CBD stones. Clinical and recurrence-free data of 112 patients with concomitant gallbladder and CBD stones who received laparoscopic cholecystectomy (LC)+laparoscopic CBD exploration (LCBDE) or LC+endoscopic retrograde cholangiopancreatography (ERCP) as an initial treatment were retrospectively reviewed and the prognostic risk factors were identified with univariate and multivariate analyses. Our findings showed EST as an independent risk factor for the recurrence of CBD stones. Patients receiving LC+ERCP had a median follow-up period of 31.3 months (range, 8-49 months), a median recurrence-free period of 25 months (range, 8-49 months), and 1-,2-and3-year recurrence-free rates of 87%, 50%, and 42%, respectively, while those undergoing LC+LCBDE had a median follow-up period of 28.7 months (range, 4-52 months), a median recurrence-free period of 24 months (range, 17-48 months), and 1-, 2-and 3-year recurrencefree rates of 96%,72%, and 67%, respectively. Multivariate analysis identified CBD diameter (>= 1 cm), angulated CBD (angle <= 145) and initial treatment options (LC+ERCP or LC+LCBDE) as independent risk factors for the recurrence of CBD stones (all P values < 0.05). It is considered that EST should be employed carefully, especially for patients with small stones that were not hard to retrieve, and LC+LCBDE seem to be a more suitable option to avoid the long-term recurrence of CBD stones.