Table 5.
Risk factors for recurrence of choledocholithiasis proposed in the literature
| Proposed risk factor | Ref. | Comment section |
| DBR | [19-21] | DBR |
| Pneumobilia | [19] | Indicative of DBR |
| Acute distal CBD angulation | [19] | Promotes bile stasis |
| CBD dilation | [19] | Promotes bile stasis |
| Periampullary diverticulum | [19] | Promotes bile stasis |
| Prior EST | [22,23] | Promotes DBR |
| Intact gallbladder with stones in situ | [22] | (Secondary) stone CBD migration |
| Billiary stricture | [22] | Promotes bile stasis |
| Papillary stenosis | [22] | Promotes bile stasis |
| ML | [22] | Small residual microlithiasis acts as nidi for stone formation |
| Stone size | [24] | Size of the largest stone |
| Cirrhosis | [22] | Delayed biliary emptying/bile stasis |
| Delayed biliary emptying | [22] | Promotes bile stasis |
| Bacterial infection/colonization of the CBD. Bacterial count | [25,26] | Promotes chronic infection, and inflammation, promotes stone formating |
| Impaired biliary flow | [25] | Scintigraphic study |
| Cholecystectomy (without stones) | [27] | Impede flushing of nidus/residual stones |
| Post-procedural sphincter function impaired | [6,27] | EST vs EPBD/EPLBD vs EPSBD, promote DBR |
| Number of sessions to clear duct at first presentation | [6] | # of ERCPs required to achieve a patent CBD |
| Age | [6] | Old age |
| Previous cholecystectomy (open or lap) | [6] | |
| Serum lvls of chol | [24] | Lithogenic properties |
| EST size | [24] | Minimal size is protective |
| Inflammation CBD | [24] | |
| Parasites of the CBD | [24] | Parasitic infection |
| Foreign bodies in the CBD | [24] | |
| Concurrent cholecystolithiasis and cholelithiasis | [28] | |
| Post stone removal CBD diameter | [21] | At 72 h after stones removal, cholangiogram via nasobiliary tube |
| EPLBD > 10 mm | [29] | Disruption of SO, DBR |
| Variations of the ABCB4, ABCB11 genes | [30] | Affect composition of bile. Associated with cholestasis, cholelithiasis and formation of primary intrahepatic stones |
| Excessive dilation of the CBD | [31] | Recurrence rate was 40% when maximum CBD diameter was more than 20 mm, whereas recurrence rate was 18% when maximum CBD diameter was 20 mm or less |
The level of evidence varies. DBR: Duodenal-biliary reflux; CBD: Common bile duct; EST: Endoscopic sphincterotomy; ML: Mechanical lithotripsy; EPBD: Endoscopic papillary balloon dilation; EPLBD: Endoscopic papillary large balloon dilation; EPSBD: Endoscopic papillary small balloon dilation; ERCP: Endoscopic retrograde cholangiopancreatography; Llv: Level; Chol: Cholesterol; SO: Sphincter of Oddi.