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Korean J Med > Volume 88(1); 2015 > Article
The Korean Journal of Medicine 2015;88(1): 38-45.
총담관담석의 내시경 치료 후 잔여 담석의 위험인자
황진원, 최정식
인제대학교 의과대학 부산백병원 내과
Risk Factors for the Presence of Residual Bile Duct Stones after Endoscopic Treatment of Stones of the Common Bile Duct
Jin Won Hwang, Jung Sik Choi
Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
Corresponding Author: Jung Sik Choi ,Tel: +82-51-890-6986, Fax: +82-51-892-0273, Email: cwj1225@naver.com
Received: March 3, 2014;   Revised: May 16, 2014;   Accepted: June 30, 2014.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Stones remaining after endoscopic treatment of common bile duct (CBD) stones may evolve into recurrent CBD stones or serve as nuclei for the growth of new CBD stones. The aim of the present study was to identify risk factors for the presence of residual stones after endoscopic treatment of CBD stones.
We performed a retrospective case-control study; 55 patients with residual stones were enrolled as the case group and 281 patients without such stones served as a control group. We collected information on age, sex, stone characteristics, laboratory findings, the presence/absence of a periampullary diverticulum, use of mechanical lithotripsy, use of (single-procedure) endoscopic papillary balloon dilatation (EPBD), presence/absence of multiple CBD stones, CBD stone size, CBD stone diameter, whether CBDs were associated with gall bladder stones, and histories of prior cholecystectomy and cholecystectomy performed after endoscopic treatment.
Upon univariate analysis, mechanical lithotripsy, single-procedure EPBD, the presence of multiple CBD stones (more than four), and CBD stone diameter greater than 1 cm were risk factors for the presence of residual stones. Upon multivariate analysis, single-procedure EPBD (odds ratio [OR], 3.174; 95% confidence interval [CI], 1.68-6.00; p = 0.000), and more than four CBD stones (OR, 2.459; 95% CI, 1.24-4.86; p = 0.010), were significant risk factors for the presence of residual stones.
Single-procedure EPBD and the presence of more than four CBD stones were independent risk factors for the presence of residual stones. Particular care, featuring meticulous inspection, is necessary when treating patients with these risk factors. A second procedure, endoscopic retrograde cholangiopancreatography, may be required.
Keywords: Common bile duct calculi; Endoscopic retrograde cholangiopancreatography
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