title: Recurrence of choledocholithiasis following endoscopic bile duct clearance: Long term results and factors associated with recurrent bile duct stones.
abstract: OBJECTIVE
  To evaluate the rate of recurrence of symptomatic choledocholithiasis and identify factors associated with the recurrence of bile duct stones in patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) for bile duct stone disease.
  
  
  METHODS
  All patients who underwent ERCP and EST for bile duct stone disease and had their bile duct cleared from 1/1/2005 until 31/12/2008 was enrolled. All symptomatic recurrences during the study period (until 31/12/2015) were recorded. Clinical and laboratory data potentially associated with common bile duct (CBD) stone recurrence were retrospectively retrieved from patients' files.
  
  
  RESULTS
  A total of 495 patients were included. Sixty seven (67) out of 495 patients (13.5%) presented with recurrent symptomatic choledocholithiasis after 35.28 ± 16.9 mo while twenty two (22) of these patients (32.8%) experienced a second recurrence after 35.19 ± 23.2 mo. Factors associated with recurrence were size (diameter) of the largest CBD stone found at first presentation (10.2 ± 6.9 mmvs7.2 ± 4.1 mm,P= 0.024), diameter of the CBD at the first examination (15.5 ± 6.3 mmvs12.0 ± 4.6 mm,P= 0.005), use of mechanical lithotripsy (ML) (P= 0.04) and presence of difficult lithiasis (P= 0.04). Periampullary diverticula showed a trend towards significance (P= 0.066). On the contrary, number of stones, angulation of the CBD, number of ERCP sessions required to clear the CBD at first presentation, more than one ERCP session needed to clear the bile duct initially and a gallbladder in situ did not influence recurrence.
  
  
  CONCLUSIONS
  Bile duct stone recurrence is a possible late complication following endoscopic stone extraction and CBD clearance. It appears to be associated with anatomical parameters (CBD diameter) and stone characteristics (stone size, use of ML, difficult lithiasis) at first presentation.
authors.affiliation: Christos Konstantakis, Department of Gastroenterology, General Hospital of Patras, 26335 Patras, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Konstantakis
authors.affiliation: Christos Konstantakis, Department of Gastroenterology, General Hospital of Patras, 26335 Patras, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Triantos
authors.affiliation: Christos Konstantakis, Department of Gastroenterology, General Hospital of Patras, 26335 Patras, Greece.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Theopistos
authors.affiliation: Christos Konstantakis, Department of Gastroenterology, General Hospital of Patras, 26335 Patras, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Theocharis
authors.affiliation: Christos Konstantakis, Department of Gastroenterology, General Hospital of Patras, 26335 Patras, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Maroulis
authors.affiliation: Christos Konstantakis, Department of Gastroenterology, General Hospital of Patras, 26335 Patras, Greece.
authors.forename: Georgia
authors.initials: G
authors.lastname: Diamantopoulou
authors.affiliation: Christos Konstantakis, Department of Gastroenterology, General Hospital of Patras, 26335 Patras, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Thomopoulos
keywords: Bile duct stone disease; Choledocholithiasis; Common bile duct angulation; Endoscopic retrograde cholangiopancreatography; Endoscopic sphincterotomy; Recurrence of choledocholithiasis