Comparison Study between ERCP and PTBD for Recurrent Choledocholithiasis in Patients Following Gastrectomy

Area of Science:

• Gastroenterology
• Hepatobiliary Surgery

Background:

• Recurrence of common bile duct stones (choledocholithiasis) exceeds 10% in the general population.
• Patients with a history of gastrectomy may have a higher incidence of gallstones, but recurrent choledocholithiasis data is lacking.
• This study addresses the knowledge gap regarding recurrent choledocholithiasis incidence and risk factors post-gastrectomy.

Purpose of the Study:

• To evaluate the recurrence rate of choledocholithiasis in patients with a history of gastrectomy.
• To identify significant risk factors associated with recurrent choledocholithiasis in this specific patient cohort.

Main Methods:

• Retrospective analysis of 131 patients with gastrectomy history undergoing choledocholithiasis removal (2011-2019).
• Treatments included endoscopic retrograde cholangiopancreatography (ERCP) (n=41) and percutaneous transhepatic biliary drainage (PTBD) (n=90).
• Gastrectomy types: subtotal (Billroth I/II) and total (Roux-en-Y). Follow-up median 31.5 months.

Main Results:

• Overall recurrence rate was 14.5% (19/131 patients) over a median follow-up of 31.5 months.
• The ERCP group showed a higher recurrence rate (24.4%) compared to the PTBD group (10.0%).
• Significant risk factors identified: ERCP use, no balloon sphincteroplasty, periampullary diverticulum, and common bile duct (CBD) stricture.

Conclusions:

• The incidence of CBD stones post-gastrectomy is comparable to the general population.
• ERCP, CBD stricture, and absence of balloon sphincteroplasty are key risk factors for recurrence.
• Recommends ERCP with active balloon sphincteroplasty to minimize recurrent CBD stones, considering PTBD disadvantages.