title: Rate of duodenal-biliary reflux increases in patients with recurrent common bile duct stones: evidence from barium meal examination.
abstract: BACKGROUND
  Stone recurrence is a common late adverse event after ERCP in patients with common bile duct stones (CBDS). Duodenal-biliary reflux (DBR) is considered a major cause of CBDS recurrence. However, specific evidence is still lacking.
  
  
  OBJECTIVE
  To investigate the DBR rate in patients with recurrent CBDS after ERCP.
  
  
  METHODS
  A prospective case-control study.
  
  
  METHODS
  A tertiary center.
  
  
  METHODS
  During follow-up, patients with a history of either recurrent CBDS (recurrence group) or nonrecurrent CBDS (control group) were invited to participate in the study. All patients had previously undergone successful CBDS removal by ERCP. Patients in the control group were matched with the recurrence group by age and gender in a 1:1 ratio. Patients with gallbladder stones, hepatolithiasis, remnant CBDS, CBD strictures, or stents were excluded.
  
  
  METHODS
  Standard barium meal examination, MRCP, and enhanced abdominal CT.
  
  
  METHODS
  DBR.
  
  
  RESULTS
  Thirty-two patients with a history of recurrent CBDS and 32 matched control subjects were enrolled. Baseline characteristics and parameters regarding the first ERCP were comparable between the 2 groups. The DBR rate was significantly higher in the recurrent than in the control group (68.8% vs 15.6%, P < .001). Multivariate analysis indicated that DBR (OR, 9.59; 95% CI, 2.65-34.76) and acute distal CBD angulation (OR, 5.48; 95% CI, 1.52-19.78) were independent factors associated with CBDS recurrence. DBR rates in patients with no, single, or multiple recurrences were 15.6%, 60.9%, and 88.9%, respectively (P < .001). Intrahepatic bile duct reflux was more common in patients with multiple recurrences.
  
  
  CONCLUSIONS
  Small sample size.
  
  
  CONCLUSIONS
  DBR is correlated with CBDS recurrence in patients who had previously undergone ERCP. DBR and acute distal CBD angulation are 2 independent risk factors related to stone recurrence. (
  
  
  BACKGROUND
  NCT02329977.)
authors.affiliation: School of Biomedical Engineering, Fourth Military Medical University, Xi'an, China; Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
authors.forename: Rongchun
authors.initials: R
authors.lastname: Zhang
authors.affiliation: School of Biomedical Engineering, Fourth Military Medical University, Xi'an, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Luo
authors.affiliation: School of Biomedical Engineering, Fourth Military Medical University, Xi'an, China.
authors.forename: Yanglin
authors.initials: Y
authors.lastname: Pan
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
authors.forename: Lina
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
authors.forename: Junqiang
authors.initials: J
authors.lastname: Dong
authors.affiliation: School of Biomedical Engineering, Fourth Military Medical University, Xi'an, China.
authors.forename: Zhiguo
authors.initials: Z
authors.lastname: Liu
authors.affiliation: School of Biomedical Engineering, Fourth Military Medical University, Xi'an, China.
authors.forename: Xiangping
authors.initials: X
authors.lastname: Wang
authors.affiliation: School of Biomedical Engineering, Fourth Military Medical University, Xi'an, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Tao
authors.affiliation: School of Biomedical Engineering, Fourth Military Medical University, Xi'an, China; Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
authors.forename: Guohua
authors.initials: G
authors.lastname: Lu
authors.affiliation: School of Biomedical Engineering, Fourth Military Medical University, Xi'an, China.
authors.forename: Xuegang
authors.initials: X
authors.lastname: Guo
mesh_terms: D000328:Adult; D000368:Aged; D001464:Barium; D001655:Bile Reflux / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D016022:Case-Control Studies; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D001464:Barium