Risk factors of acute cholecystitis after endoscopic common bile duct stone removal

AIM:To evaluate the risk factors of acute cholecystitis after endoscopic common bile duct(CBD)stone removal. METHODS:A total 100 of patients who underwent en- doscopic CBD stone removal with gallbladder(GB)in situ without subsequent cholecystectomy from January 2000 to July 2004 were evaluated retrospectively.The follow- ing factors were considered while evaluating risk factors for the development of acute cholecystitis:age,gender, serum bilirubin level,GB wall thickening,cystic duct pa- tency,presence of a GB stone,CBD diameter,residual stone,lithotripsy,juxtapapillary diverticulum,presence of liver cirrhosis or diabetes mellitus,a presenting illness of cholangitis or pancreatitis,and procedure-related compli- cations. RESULTS:During a mean 18-mo follow-up,28(28%) patients developed biliary symptoms;17(17%)acute cholecystitis and 13(13%)CBD stone recurrence. Of patients with acute cholecystitis,15(88.2%)re- ceived laparoscopic cholecystectomy and 2(11.8%) open cholecystectomy.All recurrent CBD stones were successfully removed endoscopically.The mean time elapse to acute cholecystitis was 10.2 mo(1-37 mo) and that to recurrent CBD stone was 18.4 mo.Of the 17 patients who received cholecystectomy,2(11.8%) developed recurrent CBD stones after cholecystectomy. By multivariate analysis,a serum total bilirubin level of <1.3 mg/dL and a CBD diameter of <11 mm at the time of stone removal were found to predict the development of acute cholecystitis. CONCLUSION:After CBD stone removal,there is no need for routine prophylactic cholecystectomy.However, patients without a dilated bile duct(<11 mm)and jaun- dice(<1.3 mg/dL)at the time of CBD stone removal