瀧本洋一先生（所属:慶應義塾大学医学部 消化器内科学）の論文が、J Hepatobiliary Pancreat Sci誌(Journal Citation Reports Impact Factor 2020 = 7.027)にacceptされました。本論文は、瀧本先生が当科での１年間の国内留学中(2020年度)に書いたものです。
J Hepatobiliary Pancreat Sci. 2021 Nov 26. doi: 10.1002/jhbp.1083. Online ahead of print.
The Impact of endoscopic sphincterotomy incision size on common bile duct stone recurrence: a propensity score-matching analysis
Yoichi Takimoto, Atsushi Irisawa, Koki Hoshi, Akira Yamamiya, Kazunori Nagashima, Takahito Minaguchi, Akane Yamabe, Naoya Izawa, Yasuo Haruyama, Keiichi Tominaga
PMID: 34826207 DOI: 10.1002/jhbp.1083
Background/purpose: The aim of this study is to clarify the relation between the incision size for endoscopic sphincterotomy (EST) and common bile duct stone (CBDS) recurrence.
Methods: Patients who underwent elective endoscopic treatment for CBDS between January 2013 and December 2017 were enrolled, excluding those who met the exclusion criteria. The clinical characteristics were investigated using propensity score matching analysis.
Results: A total of 243 patients were investigated. Propensity scores were calculated using multinomial logistic regression with five relevant variables (age, gender, follow-up time, maximum stone size, and bile duct diameter), which led to extraction of 188 cases to compose cohorts of the small and medium EST incision groups. The CBDS recurrence rate was 17.0% in the small incision group and 6.4% in the medium incision group. Multivariate analysis identified the medium incision as an independent predictor of CBDS recurrence (hazard ratio 0.350, 95% confidence interval 0.133-0.922, P = .034). The CBDS non-recurrence rate of the medium incision group was significantly higher than that of the small incision group (log-rank test P=.019).
Conclusions: Our findings suggest that the CBDS recurrence rate was lower in EST with medium incision size than with small incision size.
Keywords: common bile duct stones; endoscopic retrograde cholangiopancreatography; endoscopic sphincterotomy; propensity score; recurrence.