263 Short-Term Endoscopic Nasobiliary Drainage After Endoscopic Removal of Common Bile Duct Stones Reduces the Recurrence of Biliary Stones

Background and Aims: Endoscopic sphincterotomy has accepted as a standard procedure for the removal of common bile duct (CBD) stones, but the rate of recurrence of CBD stones has reported to be reaching to 15%. No effective method to prevent the recurrence of CBD stones has established. Residual minute stones or sludge may be a cause for stone growth. Recent studies using intraductal ultrasonography have shown that the recurrence rate of CBD stones after the bile duct clearance is high in patients with cholangiography-negative small stones. The aim of the present study was to evaluate the efficacy of short-term biliary drainage after the endoscopic removal of CBD stones on the prevention of stone recurrence. Methods: A total of 228 patients who underwent endoscopic sphincterotomy and achieved clearance of CBD stones on cholangiography were prospectively enrolled. The patients were randomly divided into two groups: 114 patients who followed with endoscopic nasobiliary drainage (ENBD) (drainage group, D) and the other without ENBD (non-drainage group; N). The D group underwent insertion of 6Fr ENBD tube immediately after endoscopic clearance of CBD stones and received 20ml saline solution irrigation through the ENBD tube twice a day for 7 days. The patients were carefully followed in the outpatient department and the recurrence of CBD stones was recorded for each group. Results: During the followup period ranged from 24 to 84 months (mean 37 months), recurrence of CBD stones was observed in 21 patients (9.2%). The mean time to recurrence of CBD stones was 19.1 months (range 5-72 months), and all recurrent stones were bilirubinate. Overall recurrence rate of CBD stones was 2.6% in the D group and 15.8% in the N group. There were no significant differences in the mean time to recurrence; 15.7 months in the D group vs. 19.7 months in the N group. At the time of CBD stone recurrence, 7 patients (33%) were asymptomatic and 3 patients (14%) were normal in the blood tests. Notably, the other known risk factors for recurrent CBD stones (age, dilated CBD, acute CBD angulations and the presence of a peripampullary diverticulum) were not statistically different between the two groups. Conclusion: These results demonstrate that subsequent short-term ENBD after endoscopic removal of CBD stones decreases the recurrence of biliary stones.