Rate of duodenal-biliary reflux increases in patients with recurrent common bile duct stones: evidence from barium meal examination
Rate of duodenal-biliary reflux increases in patients with recurrent common bile duct stones: evidence from barium meal examination
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复发性胆总管结石患者十二指肠胆汁反流率增加：来自钡餐检查的证据
DOI：
10.1016/j.gie.2015.03.1908
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发表时间：
2015-10-01
影响因子：
7.7
通讯作者：
Guo, Xuegang
中科院分区：
文献类型：
--
作者：
Zhang, Rongchun;Luo, Hui;Guo, Xuegang
背景：结石复发是胆总管结石（CBDS）患者ERCP后常见的晚期不良事件。十二指肠胆汁反流（DBR）被认为是CBDS复发的主要原因。目的：探讨ERCP术后复发性CBDS患者的DBR率，设计：前瞻性病例对照研究，地点：三级中心，患者：随访期间，邀请有复发性CBDS病史（复发组）或无复发性CBDS病史（对照组）的患者参加本研究。所有患者既往均通过ERCP成功取出CBDS。对照组与复发组按年龄、性别1：1配对。患者胆囊结石，肝内结石，残留的CBDS，CBD狭窄，或stents.Interventions：标准钡餐检查，MRCP，增强腹部CT。主要结果Measurements：DBR。结果：32例患者的历史复发CBDS和32个匹配的对照组。两组之间关于首次ERCP的基线特征和参数相当。复发组DBR率明显高于对照组（68.8%vs15.6%，P <0.001）。多因素分析显示，DBR（OR，9.59; 95%CI，2.65-34.76）和急性远端CBD成角（OR，5.48; 95%CI，1.52-19.78）是CBDS复发的独立相关因素。无复发、单次复发和多次复发患者的DBR率分别为15.6%、60.9%和88.9%（P <0.001）。肝内胆管反流在多次复发的患者中更为常见。局限性：样本量小。结论：DBR与既往接受过ERCP的患者的CBDS复发相关。DBR和CBD远端急性成角是与结石复发相关的2个独立风险因素。
Background: Stone recurrence is a common late adverse event after ERCP in patients with common bile duct stones (CBDS). Duodenal-biliary reflux (DBR) is considered a major cause of CBDS recurrence. However, specific evidence is still lacking.Objective: To investigate the DBR rate in patients with recurrent CBDS after ERCP.Design: A prospective case-control study.Setting: A tertiary center.Patients: During follow-up, patients with a history of either recurrent CBDS (recurrence group) or nonrecurrent CBDS (control group) were invited to participate in the study. All patients had previously undergone successful CBDS removal by ERCP. Patients in the control group were matched with the recurrence group by age and gender in a 1: 1 ratio. Patients with gallbladder stones, hepatolithiasis, remnant CBDS, CBD strictures, or stents were excluded.Interventions: Standard barium meal examination, MRCP, and enhanced abdominal CT.Main Outcome Measurements: DBR.Results: Thirty-two patients with a history of recurrent CBDS and 32 matched control subjects were enrolled. Baseline characteristics and parameters regarding the first ERCP were comparable between the 2 groups. The DBR rate was significantly higher in the recurrent than in the control group (68.8% vs 15.6%, P < .001). Multivariate analysis indicated that DBR (OR, 9.59; 95% CI, 2.65-34.76) and acute distal CBD angulation (OR, 5.48; 95% CI, 1.52-19.78) were independent factors associated with CBDS recurrence. DBR rates in patients with no, single, or multiple recurrences were 15.6%, 60.9%, and 88.9%, respectively (P < .001). Intrahepatic bile duct reflux was more common in patients with multiple recurrences.Limitations: Small sample size.Conclusions: DBR is correlated with CBDS recurrence in patients who had previously undergone ERCP. DBR and acute distal CBD angulation are 2 independent risk factors related to stone recurrence.