title: Recurrent cholangitis after endoscopic lithotripsy of common bile duct stones with gallstones in situ: predictive factors with and without subsequent cholecystectomy.
abstract: BACKGROUND
  Common bile duct stones are a frequent complication of gallstones. Endoscopic retrograde cholangiopancreatography and sphincterotomy are often performed to evaluate the etiology of obstructive jaundice and for concomitant therapeutic removal of common bile duct stones. We aimed to evaluate the recurrence rate of cholangitis or cholecystitis after endoscopic lithotripsy with gallstones in situ and to identify associated predictive factors.
  
  
  METHODS
  We retrospectively reviewed 183 patients who had received endoscopic lithotripsy between July 2007 and June 2010. We divided patients into two groups: One group who had received subsequent cholecystectomy (n=66) and one observational group (n=117). Patients with previous cholecystectomy or without gallstones were excluded. All included patients were followed up at our outpatient department. Our end point was the presence of symptoms of recurrent cholangitis or cholecystitis.
  
  
  RESULTS
  Subjects included 86 males and 97 females with a mean age of 62.5±16.3 years (range, 43-81 years). Cholangitis or cholecystitis recurred in 6 patients in the cholecystectomy group and 30 patients in the observational group. Findings revealed a lower recurrence rate and longer recurrence-free period in patients who received subsequent cholecystectomy. The recurrence rate of the observational group was significantly higher than that of the cholecystectomy group (25.6% versus 9.1%, P=.007). Univariate and multivariate Cox regression analyses revealed that common bile duct dilatation was an independent predictive factor for recurrence.
  
  
  CONCLUSIONS
  Cholecystectomy is recommended after endoscopic lithotripsy. Common bile duct dilatation is associated with the rate of recurrent cholangitis or cholecystitis.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Jian-Han
authors.initials: JH
authors.lastname: Lai
authors.forename: Horng-Yuan
authors.initials: HY
authors.lastname: Wang
authors.forename: Wen-Hsiung
authors.initials: WH
authors.lastname: Chang
authors.forename: Cheng-Hsin
authors.initials: CH
authors.lastname: Chu
authors.forename: Shou-Chuan
authors.initials: SC
authors.lastname: Shih
authors.forename: Shee-Chan
authors.initials: SC
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002761:Cholangitis / Q000209:etiology*; D002763:Cholecystectomy; D041761:Cholecystolithiasis / Q000150:complications / Q000628:therapy*; D042883:Choledocholithiasis / Q000150:complications / Q000628:therapy*; D016145:Endoscopy, Digestive System / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies