INCIDENCE AND RISK FACTORS OF REMNANT CBD STONES IN PATIENTS UNDERWENT CHOLECYSTECTOMY AFTER ENDOSCOPIC CBD STONE EXTRACTION FOR BOTH CBD STONE AND GB STONE

Aims:

Patients with choledocho- cholecystolithiasis undergo generally cholecystectomy after endoscopic CBD stone extraction. Early recurrence of CBD stone after cholecystectomy can occur due to migration of GB stone into bile duct during operation or incomplete endoscopic removal of CBD stone. The aim of this study was to investigate the incidence and risk factors of remnant CBD stones after cholecystectomy.

Methods:

A total of 139 patients (mean age 59.2yrs, male 71 (51.1%)) who underwent endoscopic CBD stones removal followed by cholecystectomy from 2011 to 2015 were included. All patients had the placement of an endoscopic nasobiliary drainage (ENBD) tube from the time after endoscopic clearance of the CBD stones to the time after the cholecystectomy. ENBD tubogram was obtained in all patients to check the recurrence of CBD stone after operation.

Results:

CBD stone recurred in 19.0% (27/139). Post operation ENBD tubogram was done after average 2.42 days of post operation. In uvivariate analysis for risk factors of remained CBD stone, CBD stone number > 2, GB stone number > 2, Cholesterol stone, Muddy CBD stone, max diameter of CBD > 15 mm, EST alone (rather than EPBD or EST with EPBD), performing endoscopic mechanical lithotripsy (EML) influenced the CBD stone recurrence with statistical significance. In multivariate analysis, CBD stone number > 2, Cholesterol stone, EML are significantly related with remained CBD stone after cholecystectomy.

Conclusions:

Considering there was relatively high rate of remnant CBD stone after cholecystectomy, a routinely consecutive ERCP after cholecystectomy is worthy to consider in patients with high risk factors.