Risk Factors for Recurrent Cholangitis after Initial Hepatolithiasis Treatment

Goals: To elucidate the risk factors that can affect the rate of cholangitis after hepatolithiasis treatment. Background: Hepatolithiasis is prevalent in East Asia and causes long-term complications. Recurrent cholangitis is one of its most serious complications and can lead to biliary stricture, liver cirrhosis, and even cholangiocarcinoma. However, little is known about the risk factors associated with cholangitis. Study: The clinical records of 193 patients with hepatolithiasis who had been newly diagnosed and treated were reviewed. The mean follow-up was 56 months (1-242 months). Results: Cumulative cholangitis rates were 25.0% at 3 years and 37.0% at 5 years. By multivariate analysis, cholangitis was associated with hepatic resection (Hazard ratio [HR] = 0.28; 95% confidence interval [CI]: 0.12-0.65), residual stones (HR = 1.77; 95% CI: 1.05-2.98), and recurrent stones (HR = 4.02; 95% CI: 1.31-12.36), but not Sphincter of Oddi disruption. Though biliary stricture did not in general affect the cholangitis rate, a stricture located in the common hepatic or common bile duct was associated with a higher rate of cholangitis than a stricture in the intrahepatic duct alone. Conclusions: Cholangitis occurs frequently in hepatolithiasis patients with a common hepatic or common bile duct stricture, residual stones, recurrent stones, and in those that are treated by nonhepatic resection.