Saline Solution Irrigation of the Bile Duct after Stone Removal Reduces the Recurrence of Common Bile Duct Stones

Saline Solution Irrigation of the Bile Duct after Stone Removal Reduces the Recurrence of Common Bile Duct Stones

RYOMA ENDO,¹ AKIHIKO SATOH,¹ YU TANAKA,¹ FUMIKO SHIMODA,¹ KAORU SUZUKI,¹ KIICHI TAKAHASHI,¹ HIDEKI OKATA,¹ KEIICHIRO HIRAMOTO,¹ OSAMU KIMURA,¹ SHO ASONUMA,¹ KEN UMEMURA¹ and TOORU SHIMOSEGAWA¹

¹Department of Gastroenterology, South Miyagi Medical Center, Shibata-gun, Miyagi, Japan

Common bile duct (CBD) stone is a relatively common but potentially life�]threatening disease. Endoscopic sphincterotomy (EST) has been performed as standard therapy for CBD stones, but the rate of recurrence of CBD stones is high. Risk factors have been poorly defined, and no effective means for the prevention of the recurrence of CBD stones have been established so far. We aimed to identify significant risk factors for the recurrence of bile duct stones. This study included 477 patients (231 women; mean age, 80.5 years) who underwent EST and cleared CBD stones on cholangiography. A retrospective analysis was performed for the consecutively collected data. During the follow-up period of 6-75 months, the recurrence of CBD stones was observed in 99 patients (20.8%). The median time to the recurrence was 19.0 months (range 4-72 months). Multivariate analysis identified the need for mechanical lithotripsy, which was used for stone fragmentation, as a risk factor. Mechanical lithotripsy caused cholangiography-negative small residua. Notably, saline solution irrigation of the bile duct reduced the recurrence of CBD stones. These results demonstrate that subsequent biliary irrigation after stone removal may prevent the recurrence of CBD stones by clearing small residual fragments.

Keywords —— biliary stone; endoscopic sphincterotomy; irrigation; lithotripsy; recurrence

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Tohoku J. Exp. Med., 2020, 250, 173-179

Correspondence: Akihiko Satoh, M.D., Ph.D., Department of Gastroenterology, South Miyagi Medical Center, 38-1 Aza-Nishi, Ohgawara-machi, Shibata-gun, Miyagi 989-1253, Japan.

e-mail: asato@bf7.so-net.ne.jp