Common bile duct morphology is associated with recurrence of common bile duct stones in Billroth II anatomy patients

doi:10.12998/wjcc.v9.i26.7671

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World Journal of Clinical Cases

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Case Control Study

World J Clin Cases. Sep 16, 2021; 9(26): 7671-7681
Published online Sep 16, 2021. doi: 10.12998/wjcc.v9.i26.7671

Common bile duct morphology is associated with recurrence of common bile duct stones in Billroth II anatomy patients

Xu Ji, Wen Jia, Qian Zhao, Yao Wang, Shu-Ren Ma, Lu Xu, Ying Kan, Yang Cao, Bao-Jun Fan, Zhuo Yang

Xu Ji, Wen Jia, Qian Zhao, Yao Wang, Shu-Ren Ma, Lu Xu, Ying Kan, Yang Cao, Bao-Jun Fan, Zhuo Yang, Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China

Xu Ji, Qian Zhao, Lu Xu, Postgraduate College, Dalian Medical University, Dalian 116044, Liaoning Province, China

Yao Wang, Bao-Jun Fan, Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang 110847, Liaoning Province, China

Ying Kan, Yang Cao, Postgraduate College, Jinzhou Medical University, Jinzhou 121001, Liaoning Province, China

Author contributions: Ji X and Yang Z contributed to drafting the final manuscript; all authors contributed to study design, data collection, statistical analysis, and reading and approving the final manuscript.

Institutional review board statement: The study was reviewed and approved by the General Hospital of Northern Theater Command Institutional Review Board.

Informed consent statement: Written informed consent was obtained from the patients or their guardian prior to the study.

Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.

Data sharing statement: No additional data are available.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Corresponding author: Zhuo Yang, MD, Chief Doctor, Department of Digestive Endoscopy, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang 110840, Liaoning Province, China. yangzhuocy@163.com

Received: April 29, 2021
Peer-review started: April 29, 2021
First decision: May 26, 2021
Revised: June 20, 2021
Accepted: July 29, 2021
Article in press: July 29, 2021
Published online: September 16, 2021
Processing time: 134 Days and 6.5 Hours

Abstract

BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) is the primary choice for removing common bile duct (CBD) stones in Billroth II anatomy patients. The recurrence of CBD stones is still a challenging problem.

AIM

To evaluate CBD morphology and other predictors affecting CBD stone recurrence.

METHODS

A retrospective case-control analysis was performed on 138 CBD stones patients with a history of Billroth II gastrectomy, who underwent therapeutic ERCP for stone extraction at our center from January 2011 to October 2020. CBD morphology and other predictors affecting CBD stone recurrence were examined by univariate analysis and multivariate logistic regression analysis.

RESULTS

CBD morphology (P < 0.01) and CBD diameter ≥ 1.5 cm (odds ratio [OR] = 6.15, 95% confidence interval [CI]: 1.87-20.24, P < 0.01) were the two independent risk factors. In multivariate analysis, the recurrence rate of patients with S type was 16.79 times that of patients with straight type (OR = 16.79, 95%CI: 4.26-66.09, P < 0.01), the recurrence rate of patients with polyline type was 4.97 times that of patients with straight type (OR = 4.97, 95%CI: 1.42-17.38, P = 0.01), and the recurrence rate of S type patients was 3.38 times that of patients with polyline type (OR = 3.38, 95%CI: 1.07-10.72, P = 0.04).

CONCLUSION

CBD morphology, especially S type and polyline type, is associated with increased recurrence of CBD stones in Billroth II anatomy patients.

Keywords: Endoscopic retrograde cholangiopancreatography; Common bile duct stones; Recurrence; Billroth II anatomy; Common bile duct morphology; Risk factors

Core Tip: Common bile duct (CBD) stone recurrence in Billroth II anatomy patients is challenging, and CBD morphology had never been noticed as a potential risk factor for CBD stone recurrence. In this study, CBD morphology was identified to be the independent risk factor for CBD stone recurrence in Billroth II anatomy patients. S type and polyline type were associated with an increased risk of recurrent CBD stones. Periodic surveillance and prophylactic therapy is recommended for Billroth II anatomy patients with S type and polyline type after successful endoscopic retrograde cholangiopancreatography.