title: The relationship between gallbladder status and recurrent biliary complications in patients with choledocholithiasis following endoscopic treatment.
abstract: BACKGROUND
  Endoscopic methods are currently the treatment of choice for patients with common bile duct (CBD) stones, but subsequent management of the intact gallbladder for patients following endoscopic treatment is still controversial. The primary aim of this study was to discover the association between gallbladder status and recurrent biliary complications for patients with CBD stones after endoscopic treatment. Additionally, we also sought to determine risk factors for recurrent biliary complications in these patients.
  
  
  METHODS
  The records of 1625 patients with CBD stones following endoscopic treatment were reviewed. A total of 681 patients were enrolled and subsequently categorized into four groups: Group 1 (n = 201), calculous gallbladder; Group 2 (n = 140), acalculous gallbladder; Group 3 (n = 175), elective cholecystectomy after endoscopic treatment; and Group 4 (n = 165), prior cholecystectomy. The basic demographics and recurrent biliary complications during follow-up among these four groups were analyzed by Chi-square test, ANOVA, Kaplan-Meier analysis, and log-rank test.
  
  
  RESULTS
  During the median follow-up period of 34 months, 133 patients (20%) with recurrent biliary complications were identified. The recurrence rates of Groups 1, 2, 3, and 4 were 29%, 11%, 15%, and 19%, respectively. Kaplan-Meier analysis showed that patients with calculous gallbladder had a significantly higher rate of recurrent biliary complication. In multivariate analysis, patients with a history of cirrhosis, juxta-papillary diverticulum, calculous gallbladder, CBD size ≥ 1.5 cm, and endoscopic management with endoscopic sphincterotomy were at a higher risk for developing biliary complications (p = 0.029, p = 0.039, p < 0.001, p = 0.002, p = 0.021, respectively.)
  
  
  CONCLUSIONS
  Patients with cholecystolithiasis and CBD stones had a higher incidence of recurrent biliary complications. For some of these patients, elective cholecystectomy following endoscopic treatment may be considered. However, routine elective cholecystectomy in patients with normal gallbladder is not appropriate because of the low recurrence of biliary complications. Whether gallbladder function affects the biliary clearance and biliary complications requires further research.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Tzung-Jiun
authors.initials: TJ
authors.lastname: Tsai
authors.forename: Kwok-Hung
authors.initials: KH
authors.lastname: Lai
authors.forename: Chiun-Ku
authors.initials: CK
authors.lastname: Lin
authors.forename: Hoi-Hung
authors.initials: HH
authors.lastname: Chan
authors.forename: E-Ming
authors.initials: EM
authors.lastname: Wang
authors.forename: Wei-Lun
authors.initials: WL
authors.lastname: Tsai
authors.forename: Jin-Shiung
authors.initials: JS
authors.lastname: Cheng
authors.forename: Hsien-Chung
authors.initials: HC
authors.lastname: Yu
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Chen
authors.forename: Ping-I
authors.initials: PI
authors.lastname: Hsu
mesh_terms: D000368:Aged; D001649:Bile Duct Diseases / Q000150:complications*; D002763:Cholecystectomy; D041761:Cholecystolithiasis / Q000150:complications* / Q000601:surgery; D042883:Choledocholithiasis / Q000150:complications / Q000601:surgery*; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors