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Outcomes of endoscopic sphincterotomy vs open choledochotomy for common bile duct stones

BACKGROUND: Endoscopic sphincterotomy (EST) for the management of common bile duct stones (CBDS) is used increasingly widely because it is a minimally invasive procedure. However, some clinical practitioners argued that EST may be complicated by post-endoscopic retrograde cholangiopancreatography (E...

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Autores principales: Zhou, Xiao-Dong, Chen, Qiao-Feng, Zhang, Yuan-Yuan, Yu, Ming-Ju, Zhong, Chang, Liu, Zhi-Jian, Li, Guo-Hua, Zhou, Xiao-Jiang, Hong, Jun-Bo, Chen, You-Xiang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350168/
https://www.ncbi.nlm.nih.gov/pubmed/30700944
http://dx.doi.org/10.3748/wjg.v25.i4.485
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author Zhou, Xiao-Dong
Chen, Qiao-Feng
Zhang, Yuan-Yuan
Yu, Ming-Ju
Zhong, Chang
Liu, Zhi-Jian
Li, Guo-Hua
Zhou, Xiao-Jiang
Hong, Jun-Bo
Chen, You-Xiang
author_facet Zhou, Xiao-Dong
Chen, Qiao-Feng
Zhang, Yuan-Yuan
Yu, Ming-Ju
Zhong, Chang
Liu, Zhi-Jian
Li, Guo-Hua
Zhou, Xiao-Jiang
Hong, Jun-Bo
Chen, You-Xiang
author_sort Zhou, Xiao-Dong
collection PubMed
description BACKGROUND: Endoscopic sphincterotomy (EST) for the management of common bile duct stones (CBDS) is used increasingly widely because it is a minimally invasive procedure. However, some clinical practitioners argued that EST may be complicated by post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and accompanied by a higher recurrence of CBDS than open choledochotomy (OCT). Whether any differences in outcomes exist between these two approaches for treating CBDS has not been thoroughly elucidated to date. AIM: To compare the outcomes of EST vs OCT for the management of CBDS and to clarify the risk factors associated with stone recurrence. METHODS: Patients who underwent EST or OCT for CBDS between January 2010 and December 2012 were enrolled in this retrospective study. Follow-up data were obtained through telephone or by searching the medical records. Statistical analysis was carried out for 302 patients who had a follow-up period of at least 5 years or had a recurrence. Propensity score matching (1:1) was performed to adjust for clinical differences. A logistic regression model was used to identify potential risk factors for recurrence, and a receiver operating characteristic (ROC) curve was generated for qualifying independent risk factors. RESULTS: In total, 302 patients undergoing successful EST (n = 168) or OCT (n = 134) were enrolled in the study and were followed for a median of 6.3 years. After propensity score matching, 176 patients remained, and all covariates were balanced. EST was associated with significantly shorter time to relieving biliary obstruction, anesthetic duration, procedure time, and hospital stay than OCT (P < 0.001). The number of complete stone clearance sessions increased significantly in the EST group (P = 0.009). The overall incidence of complications and mortality did not differ significantly between the two groups. Recurrent CBDS occurred in 18.8% (33/176) of the patients overall, but no difference was found between the EST (20.5%, 18/88) and OCT (17.0%, 15/88) groups. Factors associated with CBDS recurrence included common bile duct (CBD) diameter > 15 mm (OR = 2.72; 95%CI: 1.26-5.87; P = 0.011), multiple CBDS (OR = 5.09; 95%CI: 2.58-10.07; P < 0.001), and distal CBD angle ≤ 145° (OR = 2.92; 95%CI: 1.54-5.55; P = 0.001). The prediction model incorporating these factors demonstrated an area under the receiver operating characteristic curve of 0.81 (95%CI: 0.76-0.87). CONCLUSION: EST is superior to OCT with regard to time to biliary obstruction relief, anesthetic duration, procedure time, and hospital stay and is not associated with an increased recurrence rate or mortality compared with OCT in the management of CBDS.
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spelling pubmed-63501682019-01-30 Outcomes of endoscopic sphincterotomy vs open choledochotomy for common bile duct stones Zhou, Xiao-Dong Chen, Qiao-Feng Zhang, Yuan-Yuan Yu, Ming-Ju Zhong, Chang Liu, Zhi-Jian Li, Guo-Hua Zhou, Xiao-Jiang Hong, Jun-Bo Chen, You-Xiang World J Gastroenterol Retrospective Study BACKGROUND: Endoscopic sphincterotomy (EST) for the management of common bile duct stones (CBDS) is used increasingly widely because it is a minimally invasive procedure. However, some clinical practitioners argued that EST may be complicated by post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and accompanied by a higher recurrence of CBDS than open choledochotomy (OCT). Whether any differences in outcomes exist between these two approaches for treating CBDS has not been thoroughly elucidated to date. AIM: To compare the outcomes of EST vs OCT for the management of CBDS and to clarify the risk factors associated with stone recurrence. METHODS: Patients who underwent EST or OCT for CBDS between January 2010 and December 2012 were enrolled in this retrospective study. Follow-up data were obtained through telephone or by searching the medical records. Statistical analysis was carried out for 302 patients who had a follow-up period of at least 5 years or had a recurrence. Propensity score matching (1:1) was performed to adjust for clinical differences. A logistic regression model was used to identify potential risk factors for recurrence, and a receiver operating characteristic (ROC) curve was generated for qualifying independent risk factors. RESULTS: In total, 302 patients undergoing successful EST (n = 168) or OCT (n = 134) were enrolled in the study and were followed for a median of 6.3 years. After propensity score matching, 176 patients remained, and all covariates were balanced. EST was associated with significantly shorter time to relieving biliary obstruction, anesthetic duration, procedure time, and hospital stay than OCT (P < 0.001). The number of complete stone clearance sessions increased significantly in the EST group (P = 0.009). The overall incidence of complications and mortality did not differ significantly between the two groups. Recurrent CBDS occurred in 18.8% (33/176) of the patients overall, but no difference was found between the EST (20.5%, 18/88) and OCT (17.0%, 15/88) groups. Factors associated with CBDS recurrence included common bile duct (CBD) diameter > 15 mm (OR = 2.72; 95%CI: 1.26-5.87; P = 0.011), multiple CBDS (OR = 5.09; 95%CI: 2.58-10.07; P < 0.001), and distal CBD angle ≤ 145° (OR = 2.92; 95%CI: 1.54-5.55; P = 0.001). The prediction model incorporating these factors demonstrated an area under the receiver operating characteristic curve of 0.81 (95%CI: 0.76-0.87). CONCLUSION: EST is superior to OCT with regard to time to biliary obstruction relief, anesthetic duration, procedure time, and hospital stay and is not associated with an increased recurrence rate or mortality compared with OCT in the management of CBDS. Baishideng Publishing Group Inc 2019-01-28 2019-01-28 /pmc/articles/PMC6350168/ /pubmed/30700944 http://dx.doi.org/10.3748/wjg.v25.i4.485 Text en ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Retrospective Study
Zhou, Xiao-Dong
Chen, Qiao-Feng
Zhang, Yuan-Yuan
Yu, Ming-Ju
Zhong, Chang
Liu, Zhi-Jian
Li, Guo-Hua
Zhou, Xiao-Jiang
Hong, Jun-Bo
Chen, You-Xiang
Outcomes of endoscopic sphincterotomy vs open choledochotomy for common bile duct stones
title Outcomes of endoscopic sphincterotomy vs open choledochotomy for common bile duct stones
title_full Outcomes of endoscopic sphincterotomy vs open choledochotomy for common bile duct stones
title_fullStr Outcomes of endoscopic sphincterotomy vs open choledochotomy for common bile duct stones
title_full_unstemmed Outcomes of endoscopic sphincterotomy vs open choledochotomy for common bile duct stones
title_short Outcomes of endoscopic sphincterotomy vs open choledochotomy for common bile duct stones
title_sort outcomes of endoscopic sphincterotomy vs open choledochotomy for common bile duct stones
topic Retrospective Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350168/
https://www.ncbi.nlm.nih.gov/pubmed/30700944
http://dx.doi.org/10.3748/wjg.v25.i4.485
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