Endoscopic sphincterotomy (ES) carries a substantial risk of recurrent choledocholithiasis but retreatment with endoscopic retrograde cholangiopancreatography (ERCP) is safe and feasible.
However, long term results of repeat ERCP and risk factors for late complications are largely unknown.
Dr Sugiyama and colleagues from Tokyo in Japan designed a study to investigate the long term outcome of repeat ERCP for recurrent bile duct stones after ES.
The researchers also aimed to identify risk factors predicting late choledochal complications.
In total, the research team recruited 84 patients to undergo repeat ERCP, and in 69 patients to combine ERCP with ES for post-ES recurrent choledocholithiasis.
The researchers retrospectively investigated the long term outcomes of repeat ERCP and they assessed factors predicting late complications using multivariate analysis.
Complete stone clearance was achieved in all patients.
The researchers found that 49 patients had no visible evidence of prior sphincterotomy. 2 patients experienced early complications.
After following up participants for a period of 2.2–26.0 years, the research team found that 31 patients (37%) developed late complications, including stone recurrence (n = 26), acute acalculous cholangitis(n = 4), and acute cholecystitis (n = 1).
|Choledochal complications were successfully treated with repeat ERCP in 29 patients|
There were neither biliary malignancies nor deaths attributable to biliary disease.
In addition, multivariate analysis identified 3 independent risk factors for choledochal complications: interval between initial ES and repeat ERCP 5 years, bile duct diameter 15 mm, and periampullary diverticulum.
Choledochal complications were successfully treated with repeat ERCP in 29 patients.
Dr Sugiyama concluded, "Choledochal complications after repeat ERCP are relatively frequent but are endoscopically manageable."
"Careful follow up is necessary, particularly for patients with a dilated bile duct, periampullary diverticulum, or early recurrence."
"Repeat ERCP is a reasonable treatment even for recurrent choledocholithiasis after ES."