Long-Term Prognosis of Cholecystocholedocholithiasis in Chinese Population

Introduction: Choledocholithiasis is usually treated with endoscopic sphincterotomy (EST), laparoscopic common bile duct exploration (CBDE) (LCBDE), or laparoscopic transcystic CBDE (LTCBDE). However, the comparative long-term prognosis of these methods in terms of adverse outcomes remains uncertain. Methods: In an ambispective, multicenter, observational, open cohort study, patients with cholecystocholedocholithiasis underwent one of three treatments (EST+laparoscopic cholecystectomy (LC), LCBDE+LC, and LTCBDE+LC).The primary outcome was adverse outcomes. Results: At a median follow-up period of 2.72 years among 2708 patients, the adverse outcome rate is 9.3%. Compared with LCBDE and LTCBDE groups, EST group displayed an increased risk for adverse outcomes (HR 1.25, 95% CI 0.93-1.69, P=0.146; HR 1.77, 95% CI 1.30-2.43, P<0.001) and stone-related outcomes (HR 1.43, 95% CI 0.99-2.06, P=0.054; HR 4.36, 95% CI 2.71-7.02, P<0.001) in the unadjusted Cox model. After adjustment in the multivariable analysis, EST group still displayed an increased risk of adverse outcomes (HR 1.43, 95% CI 1.05-1.95, P=0.021; HR 1.87, 95% CI 1.35-2.59, P<0.001) and stone-related outcomes (HR 1.64, 95% CI 1.13-2.37, P=0.010; HR 4.88, 95% CI 2.99-7.97, P<0.001). Compared with LTCBDE group, LCBDE group displayed an increased risk for a stone-related outcome in both the unadjusted Cox model (HR 3.05, 95% CI 1.89-4.90, P<0.001) and the adjusted multivariable analysis (HR 2.98, 95% CI 1.83-4.86, P <0.001). Conclusion: Compared with EST, the laparoscopic technique was associated with a lower risk of adverse outcomes and stone-related outcomes after adjustment for confounding factors. In laparoscopic techniques, the risk of stone-related outcomes after LTCBDE is reduced 66.4% than LCBDE. Clinical Trial Registration: CREST Choles ClinicalTrials.gov number, NCT02554097. Funding Statement: The author(s) disclose receipt of the following financial support for the research, authorship, and/or publication of this article: this program is sponsored by Capital Health Research and Special Development (No. 2016-1-1111), National Key Technologies R&D Program (No. 2015BAI13B09), and Beijing Municipal Administration of Hospitals Incubator Program (No. PX2016001 and No. PX2019004). Declaration of Interests: The author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Ethics Approval Statement: Ethical approval was obtained at all participating centers.