Risk factors for recurrent bile duct stones after endoscopic papillary balloon dilation: long-term follow-up study.
BACKGROUND
Little is known about the long-term results of endoscopic papillary balloon dilation (EPBD) for bile duct stones.


METHODS
Between 1995 and 2000, 204 patients with bile duct stones successfully underwent EPBD and stone removal. Complete stone clearance was confirmed using balloon cholangiography and intraductal ultrasonography (IDUS). Long-term outcomes of EPBD were investigated retrospectively in the year 2007, and risk factors for stone recurrence were multivariately analyzed.


RESULTS
Long-term information was available in 182 cases (89.2%), with a mean overall follow-up duration of 9.3 years. Late biliary complications occurred in 22 patients (12.1%), stone recurrence in 13 (7.1%), cholangitis in 10 (5.5%), cholecystitis in four, and gallstone pancreatitis in one. In 11 of 13 patients (84.6%), stone recurrence developed within 3 years after EPBD. All recurrent stones were bilirubinate. Multivariate analysis identified three risk factors for stone recurrence: dilated bile duct (>15 mm), previous cholecystectomy, and no confirmation of clean duct using IDUS.


CONCLUSIONS
Approximately 7% of patients develop stone recurrence after EPBD; however, retreatment with endoscopic retrograde cholangiopancreatography is effective. Careful follow up is necessary in patients with dilated bile duct or previous cholecystectomy. IDUS is useful for reducing stone recurrence after EPBD.
Ohashi
Akira
A
Department of Internal Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Tochigi, Japan. ohashi@jichi.ac.jp
Tamada
Kiichi
K
Wada
Shinichi
S
Hatanaka
Hisashi
H
Tomiyama
Takeshi
T
Tano
Shigeo
S
Nakazawa
Katsuyuki
K
Sugano
Kentaro
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D055815:Young Adult