Factors Affecting Recurrent Choledocholithiasis After Endoscopic Biliary Sphincterotomy: A Cross-Sectional Study

Aim:The purpose of this study was to identify and analyze factors associated with the recurrence of common bile duct stones (CBDS) following endoscopic interventions, aiming to provide insights into predictors and characteristics of CBDS recurrence after endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) procedures.Methods:The study was designed as a single-center, cross-sectional study. Clinical data were collected from 271 patients with CBDS who underwent ERCP between June 2019 and December 2022. According to the diagnostic criteria for CBDS recurrence, patients were categorized into recurrence and non-recurrence groups. The assessment of predisposing risk factors for recurrent bile duct stones included various variables such as age, sex, gallbladder status, presence of periampullary diverticulum (PAD), number and diameter of bile duct stones, bile duct diameter, pre-cutting, and early complications.Results:A total of 271 patients were included in the study. CBDS recurrence occurred in 25 patients (9.2%), with a median of 18 months after ERCP and EST. Notable findings included that patients with recurrent CBDS had larger common bile duct diameters (7.5±4.5 mm vs 13±1.7 mm, p=0.037). Choledocholithiasis was more common in patients with a choledochal duct diameter ≥1.5 cm (3% vs 48%, p=0.00001). Recurrent choledocholithiasis was frequent in patients with larger stone sizes (7.3±6.5 mm vs 13.5±4.3 mm, p=0.04). The presence of PAD was correlated with a higher recurrence risk (23% vs 44%, p=0.013). The time to stone recurrence after the index ERCP and EST was 18.273±2.021 months. There was no significant difference in recurrence between patients with ≥2 CBDS and those with a single stone (41% vs 44%, p=0.35).Conclusion:Larger bile duct diameter, choledochal stone size, initial stone size, and the presence of PAD emerged as crucial indicators of recurrence risk. These findings contribute to our understanding of the prediction and management of CBDS recurrence after ERCP and EST procedures

Prevalence and Prognostic Importance of High Fibrosis-4 Index in COVID-19 Patients

Introduction. The fibrosis 4 (FIB-4) index was developed to predict advanced fibrosis in patients with liver disease. We aimed to evaluate the association of FIB-4 with risk factors for progression to critical illness in middle-aged patients hospitalized for coronavirus disease 2019 (COVID-19). Method. We included patients aged 35-65 years who were hospitalized following a positive RT-PCR SARS-Cov-2 test in a tertiary hospital. All data were obtained from the medical records of the patients during the first admission to the hospital. The FIB-4 index was calculated according to the equation (age (years) x AST (IU/L)/platelet count (10(9)/L)/root ALT (IU/L)). The FIB-4 index was divided into three categories according to the score categorisation: 2.67 = high risk. Results. A total of 619 confirmed COVID-19 patients (mean age = 52 yrs.) were included in this study; 37 (6.0%) were admitted to the intensive care unit (ICU), of which 44% were intubated and eight (1.3%) patients died during follow-up. The results of patients with high FIB-4 scores were compared with those with low FIB-4 scores. In patients with high FIB-4 scores, male gender, and advanced age, decreased neutrophil, lymphocyte, thrombocyte, and albumin counts, elevated AST, LDH, CK, ferritin, CRP, and D-dimer, and low GFR were the high-risk factors for critical illness. Additionally, the number of patients referred to ICU with high FIB-4 who died had higher scores than from those with low scores. Conclusion. The FIB-4 index derived from baseline data obtained during hospitalisation can be used as a simple, inexpensive, and straightforward indicator to predict ICU requirement and/or death in middle-aged hospitalized COVID-19 patients