Tsuchiya Shin, Tsuyuguchi Toshio, Sakai Yuji, Sugiyama Harutoshi, Miyagawa Kaoru, Fukuda Yoshihiro, Ando Takeshi, Saisho Hiromitsu, Yokosuka Osamu
Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan.
J Gastroenterol Hepatol. 2008 Oct;23(10):1590-5. doi: 10.1111/j.1440-1746.2008.05458.x. Epub 2008 Jun 12.
The aim of the present study was to determine whether additional intraductal ultrasound (IDUS) to confirm complete stone clearance decreases the recurrence rate of common bile duct stones for a 3-year period after endoscopic papillotomy (EPT).
IDUS was carried out with a thin-caliber ultrasonic probe (diameter 2.0 mm, frequency 20 MHz) via transpapillary route after stone extraction. If IDUS showed evidence of residual stones and/or sludge, endoscopic management was performed until IDUS examination was negative. A prospective study was conducted on 59 consecutive patients undergoing additional IDUS after stone extraction between January 1996 and May 2003 (IDUS group). The recurrence rate of common bile duct stones was compared with a historical control group (August 1988 to December 1995) consisting of cases that did not undergo IDUS (non-IDUS group). Potential risk factors for recurrence of common bile duct stones were assessed by univariate and multivariate analysis on logistic regression.
In 14 of 59 patients (23.7%), IDUS detected small residual stones not seen on cholangiography. The recurrence rate was 13.2% (17 of 129 patients) in the non-IDUS group and 3.4% (two of 59 patients) in the IDUS group (P < 0.05). Multivariate analysis subsequently identified non-IDUS status as an independent risk factor for recurrence (odds ratio 5.12, 95% CI 1.11-23.52, P = 0.036).
Additional IDUS to confirm complete stone clearance after EPT decreases the early recurrence rate of common bile duct stones.
本研究旨在确定在内镜乳头切开术（EPT）后3年期间，额外进行胆管内超声检查（IDUS）以确认结石完全清除是否能降低胆总管结石的复发率。
在结石取出后，通过经乳头途径使用细口径超声探头（直径2.0 mm，频率20 MHz）进行IDUS检查。如果IDUS显示有残留结石和/或胆泥的迹象，则进行内镜处理，直至IDUS检查结果为阴性。对1996年1月至2003年5月期间连续59例结石取出后接受额外IDUS检查的患者进行了前瞻性研究（IDUS组）。将胆总管结石的复发率与一个历史对照组（1988年8月至1995年12月）进行比较，该对照组由未接受IDUS检查的病例组成（非IDUS组）。通过对逻辑回归进行单因素和多因素分析，评估胆总管结石复发的潜在危险因素。
在59例患者中的14例（23.7%）中，IDUS检测到胆管造影未发现的小残留结石。非IDUS组的复发率为13.2%（129例患者中的17例），IDUS组为3.4%（59例患者中的2例）（P < 0.05）。多因素分析随后确定非IDUS状态是复发的独立危险因素（比值比5.12，95%可信区间1.11 - 23.52，P = 0.036）。
EPT后额外进行IDUS以确认结石完全清除可降低胆总管结石的早期复发率。
