title: Correlation of CBD/CHD angulation with recurrent cholangitis in patients treated with ERCP.
abstract: OBJECTIVE
  Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) for bile duct stone extraction has a major role in the treatment of cholangitis. It is well known that certain risk factors predispose to recurrence of such stones. The aims of this study were to evaluate the correlation between angulation of the common bile duct (CBD), right hepatic duct (RHD), and left hepatic duct (LHD) with recurrent cholangitic attacks and to elucidate other risk factors that may be associated with these attacks.
  
  
  METHODS
  This is retrospective study included 62 patients who had undergone therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for bile duct stones. Their medical records were followed until May 1, 2009. The RHD, LHD, and CBD angulation and CBD diameter were measured on cholangiography prior to any endoscopic procedures.
  
  
  RESULTS
  Among these 62 patients, 6 (9.7 %) had recurrence of cholangitis. Both angles of the RHD and the CBD were significantly smaller in the group with recurrence (P = 0.001, P = 0.004). A CBD angle ≤ 130(o) and RHD angle ≤ 125(o) were found to be significantly associated with an increased risk of recurrence (RR = 10.526, P = 0.033; RR = 24.97, P = 0.008) in multivariate analysis. Cholecystectomy was not a protective factor against recurrence of cholangitis (P = 0.615).
  
  
  CONCLUSIONS
  Angulation of the CBD (≤ 130°) and RHD (≤ 125°) on ERCP are independent risk factors for recurrent cholangitis. Further prospective studies using these data may be warranted for a more accurate estimation and verification of the risk factors predisposing to recurrent cholangitis.
authors.affiliation: Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong.
authors.forename: Charing Cn
authors.initials: CC
authors.lastname: Chong
authors.affiliation: Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong; Institute of Digestive Diseases, Prince of Wales Hospital, The Chinese University of Hong Kong.
authors.forename: Philip Wy
authors.initials: PW
authors.lastname: Chiu
authors.affiliation: Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong.
authors.forename: Teresa
authors.initials: T
authors.lastname: Tan
authors.affiliation: Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong.
authors.forename: Anthony Yb
authors.initials: AY
authors.lastname: Teoh
authors.affiliation: Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong.
authors.forename: Kit Fai
authors.initials: KF
authors.lastname: Lee
authors.affiliation: Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong; Institute of Digestive Diseases, Prince of Wales Hospital, The Chinese University of Hong Kong.
authors.forename: Enders Kwok Wai
authors.initials: EK
authors.lastname: Ng
authors.affiliation: Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong; Institute of Digestive Diseases, Prince of Wales Hospital, The Chinese University of Hong Kong.
authors.forename: Paul Bs
authors.initials: PB
authors.lastname: Lai
authors.affiliation: Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong; Institute of Digestive Diseases, Prince of Wales Hospital, The Chinese University of Hong Kong.
authors.forename: James Yw
authors.initials: JY
authors.lastname: Lau