939
LONG-TERM OUTCOMES OF ENDOSCOPIC REMOVAL OF COMMON BILE DUCT STONES IN PATIENTS AFTER ROUX-EN-Y GASTRECTOMY
Date
May 20, 2024
Background:
ERCP using a balloon-assisted endoscope (BE-ERCP) has been a first-line treatment modality for common bile duct (CBD) stones in patients after gastrectomy and Roux-en-Y (R-Y) reconstruction. Despite its favorable short-term outcomes, evidence is lacking on the long-term outcomes, including stone recurrence after complete stone removal.
Methods:
Consecutive patients after R-Y gastrectomy who underwent BE-ERCP for CBD stones in the tertiary care center were retrospectively analyzed. A short-type double-balloon endoscope and conventional ERCP devices were used in this study. After confirming complete stone removal, patients were regularly followed up for at least one year by blood tests and imaging studies as appropriate. Stone recurrence within six months was diagnosed as residual stones. This study evaluated stone recurrence during long-term follow-up, and predictive factors and their hazard ratio (HR) were computed using a Cox proportional hazard model.
Results:
Between March 2009 and February 2023, 186 patients were treated by BE-ERCP, and 149 (80.1%) patients achieved complete stone removal. Among them, 91 (48.9%) patients were followed up for over a year, except three patients who experienced early recurrence due to residual stones. They were 71.4% male with a median age of 74 (interquartile range [IQR], 71-80). Total and distal gastrectomy were 54% and 46%, respectively, mainly for gastric cancer (95.6%). A stone diameter was 9 (6-11)mm, and multiple stones in 48%. Endoscopic papillary balloon dilation was performed in all cases with a balloon diameter of 10 (8-12.5)mm. Any type of lithotripsy was applied in 40.7%. The total treatment time was 75 (48-97) minutes with 1 (1-2) endoscopic sessions. The early adverse event rate was 16.5%, most of which were managed conservatively. During a follow-up of 4.0 (2.0-5.8) years, 15 (16.5%) recurrences were reported. 1-, 3-, and 5-year cumulative recurrence rates were 4.4%, 13.0%, and 18.7%, respectively. In a multivariable analysis, a stone diameter ≥10mm (HR, 4.73) and gallbladder in situ with stones (compared to prophylactic cholecystectomy; HR, 12.6) were predictive factors for stone recurrence.
Conclusion:
In patients after R-Y gastrectomy, CBD stone recurrence occurred 3-5% per year after complete stone removal. Prophylactic cholecystectomy could prevent stone recurrence in patients with gallbladder stones.
ERCP using a balloon-assisted endoscope (BE-ERCP) has been a first-line treatment modality for common bile duct (CBD) stones in patients after gastrectomy and Roux-en-Y (R-Y) reconstruction. Despite its favorable short-term outcomes, evidence is lacking on the long-term outcomes, including stone recurrence after complete stone removal.
Methods:
Consecutive patients after R-Y gastrectomy who underwent BE-ERCP for CBD stones in the tertiary care center were retrospectively analyzed. A short-type double-balloon endoscope and conventional ERCP devices were used in this study. After confirming complete stone removal, patients were regularly followed up for at least one year by blood tests and imaging studies as appropriate. Stone recurrence within six months was diagnosed as residual stones. This study evaluated stone recurrence during long-term follow-up, and predictive factors and their hazard ratio (HR) were computed using a Cox proportional hazard model.
Results:
Between March 2009 and February 2023, 186 patients were treated by BE-ERCP, and 149 (80.1%) patients achieved complete stone removal. Among them, 91 (48.9%) patients were followed up for over a year, except three patients who experienced early recurrence due to residual stones. They were 71.4% male with a median age of 74 (interquartile range [IQR], 71-80). Total and distal gastrectomy were 54% and 46%, respectively, mainly for gastric cancer (95.6%). A stone diameter was 9 (6-11)mm, and multiple stones in 48%. Endoscopic papillary balloon dilation was performed in all cases with a balloon diameter of 10 (8-12.5)mm. Any type of lithotripsy was applied in 40.7%. The total treatment time was 75 (48-97) minutes with 1 (1-2) endoscopic sessions. The early adverse event rate was 16.5%, most of which were managed conservatively. During a follow-up of 4.0 (2.0-5.8) years, 15 (16.5%) recurrences were reported. 1-, 3-, and 5-year cumulative recurrence rates were 4.4%, 13.0%, and 18.7%, respectively. In a multivariable analysis, a stone diameter ≥10mm (HR, 4.73) and gallbladder in situ with stones (compared to prophylactic cholecystectomy; HR, 12.6) were predictive factors for stone recurrence.
Conclusion:
In patients after R-Y gastrectomy, CBD stone recurrence occurred 3-5% per year after complete stone removal. Prophylactic cholecystectomy could prevent stone recurrence in patients with gallbladder stones.
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