Department of Gastroenterology, Fuyang People's Hospital, Fuyang, China.
Surg Laparosc Endosc Percutan Tech. 2022 Aug 1;32(4):481-487. doi: 10.1097/SLE.0000000000001059.
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.
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.
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).
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.
内镜下鼻胆管引流术（ENBD）通常在经内镜逆行胰胆管造影术（ERCP）取出胆总管结石后保留数天。ENBD 放置提供可靠的胆道引流和灌注，可预防胰腺炎，并允许进行胆管造影。然而，尚未确定 ENBD 的保留时间是否与 ERCP 后有症状的胆总管结石复发有关。基于此，我们评估了 ENBD 保留时间对 ERCP 后有症状的胆总管结石复发的影响。
回顾性分析了 1016 例经诊断为胆总管结石并接受 ERCP 以取出胆总管结石的患者。他们的 ENBD 保留时间为 4.01±1.53 天。根据平均值，将他们分为第 1 组（n=570）和第 2 组（n=446）。比较两组患者 ERCP 后有症状的胆总管结石复发的累积复发率。为了确定与有症状的胆总管结石复发相关的独立因素，还记录了与组间差异相关的各种可能的预测因素。
第 1 组 ENBD 保留时间≤4.01 天的患者有 570 例（组 1），第 2 组 ENBD 保留时间＞4.01 天的患者有 446 例（组 2）。两组患者在人口统计学因素和实验室结果方面除了淀粉酶（AMY）和 ERCP 后开始进食时间外，没有明显差异。第 1 组的中位（四分位距）随访时间为 23.7（14.6，32.13）个月（范围：4.3 至 70 个月），第 2 组为 23.7（14.6，31.2）个月（范围：4.2 至 69.4 个月）（P=0.762）。第 1 组和第 2 组的有症状的胆总管结石复发累积率分别为第 20 个月时 3.1%（2.5%比 3.8%）、第 40 个月时 6.7%（5.1%比 8.7%）和第 60 个月时 8.2%（6.7%比 10.1%）（P=0.048）。多变量分析显示，第 1 组降低了有症状的胆总管结石复发的风险，风险比为 0.641（95%置信区间：0.416-0.987，P=0.044）。
这项初步研究表明，ERCP 后有症状的胆总管结石复发可能与 ENBD 保留时间有关，尤其是 ENBD 持续时间超过 4.01 天。
