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Long-term follow-up after peroral cholangioscopy-directed lithotripsy in patients with difficult bile duct stones, including Mirizzi syndrome: an analysis of risk factors predicting stone recurrence.

AbstractBACKGROUND:
Peroral cholangioscopy-directed lithotripsy (PC-directed lithotripsy) has been successfully used for the treatment of difficult bile duct stones, including Mirizzi syndrome (MS). However, long-term outcome and risk factors for stone recurrence after PC-directed lithotripsy have not yet been elucidated. The aim of this study was to assess the outcomes of long-term follow-up after PC-directed lithotripsy and to clarify risk factors predicting stone recurrence.
METHODS:
One hundred twenty-two consecutive patients with difficult bile duct stones, including MS type II (McSherry classification system), were included in the study.
RESULTS:
Successful stone removal was achieved in 117 (95.9%) of the 122 patients treated with PC-directed lithotripsy. Of these 117 patients, reliable follow-up information for a median period of 5.5 years (range=0.19-16.6) was obtained for 111 patients (94.9%) in whom stone type was classified into one of the following three categories: (1) MS type II (47 patients); (2) impacted stones (45 patients); and (3) large stones (≥20 mm in short diameter, 19 patients). Bile duct stone recurrence was observed in 18 patients (16.1%), of whom 4 had MS type II, 9 had impacted stones, and 5 had large stones. Statistical analysis showed that dilated bile duct diameter greater than or equal to 20 mm was the only risk factor for stone recurrence.
CONCLUSIONS:
PC-directed lithotripsy used for the treatment of difficult bile duct stones, including MS type II and impacted stones, and is found to be safe at long-term follow-up. Dilated bile duct diameter is the only risk factor for stone recurrence. Careful follow-up is indispensable, particularly for patients with dilated bile ducts.
AuthorsToshio Tsuyuguchi, Yuji Sakai, Harutoshi Sugiyama, Takeshi Ishihara, Osamu Yokosuka
JournalSurgical endoscopy (Surg Endosc) Vol. 25 Issue 7 Pg. 2179-85 (Jul 2011) ISSN: 1432-2218 [Electronic] Germany
PMID21184106 (Publication Type: Journal Article)
Topics
  • Adult
  • Aged
  • Aged, 80 and over
  • Chi-Square Distribution
  • Cholangiopancreatography, Endoscopic Retrograde
  • Endoscopy, Digestive System
  • Female
  • Follow-Up Studies
  • Gallstones (diagnostic imaging, therapy)
  • Humans
  • Lithotripsy (methods)
  • Male
  • Middle Aged
  • Mirizzi Syndrome (diagnostic imaging, therapy)
  • Proportional Hazards Models
  • Recurrence
  • Risk Factors
  • Treatment Outcome

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