Liu J, Wei X-J, Yang Z-L, Liao X-Y, Wu L-H, Zheng Y-P, Zheng J-H, Hu Y-Q, Zheng X-L
Department of Endoscopy, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
Eur Rev Med Pharmacol Sci. 2023 Mar;27(6):2504-2513. doi: 10.26355/eurrev_202303_31784.
Common bile duct stone (CBDS) is one of the common diseases in the digestive system, for which endoscopic retrograde cholangiopancreatography (ERCP) is a treatment procedure. However, the risk factors for CBDS recurrence after ERCP remains unclear. This study aims to compare the risk factors of CBDS recurrence after ERCP, and to set up a nomogram model to predict the long-term risk.
A retrospective analysis of 355 patients was reviewed. Univariate and multivariate analyses were performed to identify the risk factors for recurrence. The R packages were used for the model building. The validation set contained 100 patients.
The patients were divided into three subgroups: treated by cholecystectomy after ERCP (11.76% recurrence rate), treated without surgery after ERCP (19.70%), and with a prior history of cholecystectomy (43.64%). Each of them has different independent risk factors, and high body mass index (BMI) is correlated with an increased risk among all the subgroups. A prior history of cholecystectomy is a candidate factor that increases the risk of CBDS recurrence in patients older than 60 years, with a greater BMI, or receiving ERCP combined with EPBD. We built a nomogram model to predict the risk of long-term CBDS recurrence based on the risk factors including age, BMI, CBD diameter, the number of CBDS, and the gallbladder- or biliary tract-related events.
CBDS recurrence is related to congenital and anatomical factors. Cholecystectomy would not be helpful to prevent CBDS recurrence, and a prior history of cholecystectomy may indicate a high risk of recurrence.
胆总管结石（CBDS）是消化系统常见疾病之一，内镜逆行胰胆管造影术（ERCP）是其治疗手段。然而，ERCP术后CBDS复发的危险因素尚不清楚。本研究旨在比较ERCP术后CBDS复发的危险因素，并建立列线图模型以预测长期风险。
对355例患者进行回顾性分析。进行单因素和多因素分析以确定复发的危险因素。使用R软件包进行模型构建。验证集包含100例患者。
患者分为三个亚组：ERCP术后行胆囊切除术（复发率11.76%）、ERCP术后未行手术（复发率19.70%）以及有胆囊切除史（复发率43.64%）。每个亚组都有不同的独立危险因素，且高体重指数（BMI）在所有亚组中均与风险增加相关。胆囊切除史是60岁以上、BMI较高或接受ERCP联合内镜下乳头括约肌球囊扩张术（EPBD）的患者中增加CBDS复发风险的一个候选因素。我们基于年龄、BMI、胆总管直径、CBDS数量以及胆囊或胆道相关事件等危险因素构建了一个列线图模型，以预测长期CBDS复发风险。
CBDS复发与先天性和解剖学因素有关。胆囊切除术无助于预防CBDS复发，且胆囊切除史可能提示复发风险较高。
