Wen Ningyuan, Wang Yaoqun, Cai Yulong, Nie Guilin, Yang Sishu, Wang Shaofeng, Xiong Xianze, Li Bei, Lu Jiong, Cheng Nansheng
Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Expert Rev Gastroenterol Hepatol. 2023 Jul-Dec;17(9):937-947. doi: 10.1080/17474124.2023.2242784. Epub 2023 Aug 3.
Common bile duct stones (CBDS) have a reported recurrence rate of 4%-24% after stone extraction. The most commonly applied stone extraction method is endoscopic cholangiopancreatography (ERCP). We conducted a systematic review and meta-analysis to identify all available risk factors for recurrent CBDS following stone retraction.
A literature search of studies with case-control design was performed to identify potential risk factors for recurrent CBDS. The impact of different risk factors on stone recurrence was analyzed. Pooled odds ratios (ORs) with 95% CIs and heterogeneity were calculated. Identified risk factors were graded as 'strong,' 'moderate,' or 'weak' after quality assessment.
A total of 46 studies discussing stone recurrence following ERCP treatment were included. CBD diameter1.5 cm, sharp CBD angulation, multiple ERCP sessions, postoperative pneumobilia, history of CBD incision, and biliary stent placement were identified as strong risk factors; larger CBD diameter, periampullary diverticulum, mechanical lithotripsy, and history of cholecystectomy were identified as moderate. Other weak risk factors were also listed.
In this comprehensive study, we identified 14 risk/protective factors for recurrent CBDS following ERCP. Pooled odds ratios were calculated and evaluated the quality of evidence. These findings may shed light on the assessment and management of CBDS.
据报道，胆总管结石（CBDS）取石术后复发率为4%-24%。最常用的取石方法是内镜逆行胰胆管造影（ERCP）。我们进行了一项系统评价和荟萃分析，以确定结石取出后复发性CBDS的所有可用危险因素。
对采用病例对照设计的研究进行文献检索，以确定复发性CBDS的潜在危险因素。分析了不同危险因素对结石复发的影响。计算了合并比值比（OR）及其95%置信区间（CI）和异质性。在质量评估后，将确定的危险因素分为“强”、“中”或“弱”等级。
共纳入46项讨论ERCP治疗后结石复发的研究。胆总管直径≥1.5 cm、胆总管锐角、多次ERCP操作、术后气腹、胆总管切开史和胆管支架置入被确定为强危险因素；胆总管直径较大、壶腹周围憩室、机械碎石术和胆囊切除术史被确定为中度危险因素。还列出了其他弱危险因素。
在这项综合性研究中，我们确定了ERCP术后复发性CBDS的14个风险/保护因素。计算了合并比值比并评估了证据质量。这些发现可能有助于胆总管结石的评估和管理。
