Risk Factors Related to the Need for Endoscopic Retrograde Cholangiopancreatography Intervention in Cholelithiasis and Choledocholithiasis

Background and Aims: Cholelithiasis is associated with several risk factors. Moreover, cholelithiasis and choledocholithiasis share some risk factors. The risk stratification of pure gallbladder (GB) stones, as well as GB stones with common bile duct (CBD) stones and pure CBD stones requiring therapeutic endoscopic retrograde cholangiopancreatography (ERCP), has not been fully elucidated. Methods: From Taiwan's National Health Insurance Research Database (NHIRD), we identified 20671 cholelithiasis patients and 62013 control subjects (matched by sex and age in 1:3 ratio) during the period 2004-2011. We compared the risk factors for cholelithiasis patients and normal control group. Further evaluations were performed on patients with pure GB stones and patients with GB and CBD stones and patients with pure CBD stones who underwent therapeutic ERCP. Results: Coronary artery disease, hyperlipidemia, chronic kidney disease, end stage renal disease on regular hemodialysis, hepatitis B infection, liver cirrhosis, diabetes mellitus, and hemolysis were risk factors for cholelithiasis. Risk factors for GB and CBD stone patients needing ERCP included male gender (odds ratio: 1.211, 95% CI: 1.039-1.436, p value = 0.015), age over 60 (odds ratio: 1.912, 95% CI: 1.492-2.450, p value ＜0.001), and hemolysis (odds ratio: 1.719, 95% CI: 1.008-2.929, p value = 0.047). For pure CBD stone patients needing ERCP, risk factors were male gender (odds ratio: 1.496, 95% CI: 1.195-1.874, p value ＜0.001), age 41-60 (odds ratio: 2.344, 95% CI: 1.503-3.654, p value ＜0.001), and age over 60 (odds ratio: 4.484, 95% CI: 2.896-6.943, p value ＜0.001). There was lower incidence of pure CBD stones requiring ERCP among those with hyperlipidemia (odds ratio: 0.613, 95% CI: 0.469-0.802, p value ＜0.001). Conclusion: Male gender and advanced age play significant roles in the requirement for therapeutic ERCP among cholelithiasis patients.