Abstract | BACKGROUND: 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.
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Authors | Toshio Tsuyuguchi, Yuji Sakai, Harutoshi Sugiyama, Takeshi Ishihara, Osamu Yokosuka |
Journal | Surgical endoscopy
(Surg Endosc)
Vol. 25
Issue 7
Pg. 2179-85
(Jul 2011)
ISSN: 1432-2218 [Electronic] Germany |
PMID | 21184106
(Publication Type: Journal Article)
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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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