{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T22:52:47Z","timestamp":1784069567157,"version":"3.55.0"},"reference-count":33,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: Most studies assess risk factors for common bile duct (CBD) stones in patients with gallbladder in situ. We aimed to assess risk factors for CBD stones in patients with previous cholecystectomy in a proof-of-concept study. Methods: We enrolled consecutive patients undergoing EUS for suspected symptomatic CBD stones and recorded demographic variables, clinical presentation, liver function tests (LFTs), and transabdominal ultrasound (US) findings. EUS was used as gold standard for CBD stones. Multivariate analysis was used to identify risk factors in the training set; a model was created and tested on the validation set. Results: A total of 211 patients (25.6% male; median age, 66 [49\u201375] years old) were enrolled; 77.7% presented with abdominal pain, 30.3% with hyperbilirubinemia, 26.5% with pancreatitis, and 61.1% with LFT alterations. Ultrasound showed CBD dilation in 37.4% patients. Overall, 96 (45.5%) patients had CBD stones. According to multivariate analysis, male gender (OR 2.54 [1.26\u20135.09]; p = 0.009), age &gt; 63 years (OR 3.06 [1.63\u20135.72]; p &lt; 0.001), LFT alteration (OR 2.62 [1.40\u20134.91]; p = 0.003), and CBD dilation (OR 2.46 [1.31\u20134.65]; p = 0.005) were independently related to CBD stones. A model was created based on the number of risk factors on admission; patients with no risk factor had a 9.5% prevalence of CBD stones; those with one risk factor, 26.7%; two risk factors, 53.2%; three risk factors, 66.7%; and four risk factors, 100%. Conclusions: The results of this proof-of-concept study identify male gender, age, LFT alteration, and CBD dilation as risk factors for CBD stones in patients with previous cholecystectomy. An adequate assessment of the pre-test probability will guide patients\u2019 subsequent management.<\/jats:p>","DOI":"10.3390\/jcm14134532","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T06:55:13Z","timestamp":1750920913000},"page":"4532","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Risk Factors for Common Bile Duct Stones in Patients with Previous Cholecystectomy: A Multicenter Prospective Proof-of-Concept Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7724-7402","authenticated-orcid":false,"given":"Andrea","family":"Lisotti","sequence":"first","affiliation":[{"name":"Gastroenterology Unit, Hospital of Imola, University of Bologna, 40026 Imola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Togliani","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, University Hospital Borgo Trento, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graziella","family":"Masciangelo","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Hospital of Imola, University of Bologna, 40026 Imola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0895-1225","authenticated-orcid":false,"given":"Angelo","family":"Bruni","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Universit\u00e0 di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5326-0532","authenticated-orcid":false,"given":"Emilija","family":"Rakichevikj","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Hospital of Imola, University of Bologna, 40026 Imola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Vilmann","sequence":"additional","affiliation":[{"name":"Gastro Unit, Herlev and Gentofte Hospital, 2730 Herlev, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, 1172 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2924-4717","authenticated-orcid":false,"given":"Vincenzo Giorgio","family":"Mirante","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, University Hospital Borgo Trento, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4397-9314","authenticated-orcid":false,"given":"Pietro","family":"Fusaroli","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Hospital of Imola, University of Bologna, 40026 Imola, Italy"},{"name":"Department of Medical and Surgical Sciences, Universit\u00e0 di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (EASL) (2016). EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J. Hepatol., 65, 146\u2013181.","DOI":"10.1016\/j.jhep.2016.03.005"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1055\/a-0862-0346","article-title":"Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline","volume":"51","author":"Manes","year":"2019","journal-title":"Endoscopy"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1136\/gut.2007.121657","article-title":"Guidelines on the management of common bile duct stones (CBDS)","volume":"57","author":"Williams","year":"2008","journal-title":"Gut"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1007\/s00464-001-0005-7","article-title":"Practical recommendations for the prediction and management of common bile duct stones in patients with gallstones","volume":"15","author":"Kama","year":"2001","journal-title":"Surg. Endosc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/S0016-5107(04)01457-9","article-title":"The elective evaluation of patients with suspected choledocholithiasis undergoing laparoscopic cholecystectomy","volume":"60","author":"Tse","year":"2004","journal-title":"Gastrointest. Endosc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.gie.2007.09.047","article-title":"EUS: A meta-analysis of test performance in suspected choledocholithiasis","volume":"67","author":"Tse","year":"2008","journal-title":"Gastrointest. Endosc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.gie.2009.09.041","article-title":"for the ASGE Standards of Practice Committee. The role of endoscopy in the evaluation of suspected choledocholithiasis","volume":"71","author":"Maple","year":"2010","journal-title":"Gastrointest. Endosc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1055\/s-2007-966264","article-title":"Endoscopic ultrasound versus endoscopic retrograde cholangiography for patients with intermediate probability of bile duct stones: A randomized trial comparing two management strategies","volume":"39","author":"Polkowski","year":"2007","journal-title":"Endoscopy"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1007\/s10620-009-0836-y","article-title":"Does cholecystectomy status influence the common bile duct diameter? A matched-pair analysis","volume":"55","author":"Chawla","year":"2010","journal-title":"Dig. Dis. Sci."},{"key":"ref_10","first-page":"534","article-title":"Twenty to thirty year follow-up after cholecystectomy","volume":"43","author":"Sand","year":"1996","journal-title":"Hepatogastroenterology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.dld.2015.10.007","article-title":"Reliability of endoscopic ultrasound in predicting the number and size of common bile duct stones before endoscopic retrograde cholangiopancreatography","volume":"48","author":"Fusaroli","year":"2016","journal-title":"Dig. Liver Dis."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Hajong, R., Medhi, B., Rabha, P., Baruah, A.J., Boruah, P., Aggarwal, S., Devi, K.M., Ronrang, L., and Debnath, S. (2025). A Prospective Comparative Study of Laparoscopic Common Bile Duct Exploration and Endoscopic Retrograde Cholangiopancreatography for Managing Common Bile Duct Calculi. Cureus, 17.","DOI":"10.7759\/cureus.82827"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Pogoreli\u0107, Z., Lovri\u0107, M., Juki\u0107, M., and Perko, Z. (2022). The Laparoscopic Cholecystectomy and Common Bile Duct Exploration: A Single-Step Treatment of Pediatric Cholelithiasis and Choledocholithiasis. Children, 9.","DOI":"10.3390\/children9101583"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1007\/s11605-023-05594-z","article-title":"Laparoscopic Transcystic Common Bile Duct Exploration: 8-Year Experience at a Single Institution","volume":"27","author":"Huang","year":"2023","journal-title":"J. Gastrointest. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1053\/j.gastro.2015.09.002","article-title":"A Prediction Rule for Risk Stratification of Incidentally Discovered Gallstones: Results From a Large Cohort Study","volume":"150","author":"Shabanzadeh","year":"2016","journal-title":"Gastroenterology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1882","DOI":"10.1097\/HEP.0000000000000264","article-title":"Increasing gallstone disease prevalence and associations with gallbladder and biliary tract mortality in the US","volume":"77","author":"Ruhl","year":"2023","journal-title":"Hepatology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1002\/hep.26563","article-title":"Elevated body mass index as a causal risk factor for symptomatic gallstone disease: A Mendelian randomization study","volume":"58","author":"Stender","year":"2013","journal-title":"Hepatology"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Gerbasi, L., Gunsberger, T., Santarelli, A., and Ashurst, J. (2025). Comparing the Sensitivity and Specificity of Computed Tomography and Ultrasound in the Diagnosis of Acute Cholecystitis in a Rural Setting. Cureus, 17.","DOI":"10.7759\/cureus.80316"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Wang, X., Zhang, H., Bai, Z., Xie, X., and Feng, Y. (2024). Current status of artificial intelligence analysis for the diagnosis of gallbladder diseases using ultrasonography: A scoping review. Transl. Gastroenterol. Hepatol., 10.","DOI":"10.21037\/tgh-24-61"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1016\/j.acra.2023.09.029","article-title":"The Accuracy of Point-of-Care Ultrasound in the Detection of Gallbladder Disease: A Meta-analysis","volume":"31","author":"Wu","year":"2024","journal-title":"Acad. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Fusaroli, P., and Lisotti, A. (2021). EUS and ERCP in the Same Session for Biliary Stones: From Risk Stratification to Treatment Strategy in Different Clinical Conditions. Medicina, 57.","DOI":"10.3390\/medicina57101019"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1055\/a-2240-9414","article-title":"Perspectives and awareness of endoscopy healthcare professionals on sustainable practices in gastrointestinal endoscopy: Results of the LEAFGREEN survey","volume":"56","author":"Neves","year":"2024","journal-title":"Endoscopy"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"6977","DOI":"10.1007\/s00464-020-08210-2","article-title":"Safety and sedation-associated adverse event reporting among patients undergoing endoscopic cholangiopancreatography: A comparative systematic review and meta-analysis","volume":"35","author":"McCarty","year":"2021","journal-title":"Surg. Endosc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1055\/a-2219-0826","article-title":"Urgent ERCP performed with single-use duodenoscope (SUD) in patients with moderate-to-severe cholangitis: Single-center prospective study","volume":"12","author":"Masciangelo","year":"2024","journal-title":"Endosc. Int. Open"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Sha, Y., Wang, Z., Tang, R., Wang, K., Xu, C., and Chen, G. (2024). Modern Management of Common Bile Duct Stones: Breakthroughs, Challenges, and Future Perspectives. Cureus, 16.","DOI":"10.7759\/cureus.75246"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1016\/j.dld.2013.01.023","article-title":"Single-session endosonography and endoscopic retrograde cholangiopancreatography for biliopancreatic diseases is feasible, effective and cost beneficial","volume":"45","author":"Gornals","year":"2013","journal-title":"Dig. Liver Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1080\/00365521.2021.1955148","article-title":"Same day endoscopic retrograde cholangio-pancreatography immediately after endoscopic ultrasound for choledocholithiasis is feasible, safe and cost-effective","volume":"56","author":"Sbeit","year":"2021","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1007\/s00535-016-1278-x","article-title":"Procalcitonin is a useful biomarker to predict severe acute cholangitis: A single-center prospective study","volume":"52","author":"Umefune","year":"2017","journal-title":"J. Gastroenterol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"171","DOI":"10.4318\/tjg.2011.0186","article-title":"Relationship of CA 19-9 with choledocholithiasis and cholangitis","volume":"22","author":"Kara","year":"2011","journal-title":"Turk. J. Gastroenterol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1007\/s11605-023-05607-x","article-title":"Length of the Remnant Cystic Duct and Bile Duct Stone Recurrence: A Case\u2013Control Study","volume":"27","author":"Burckhardt","year":"2023","journal-title":"J. Gastrointest. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1080\/17474124.2023.2242784","article-title":"Risk factors for recurrent common bile duct stones: A systematic review and meta-analysis","volume":"17","author":"Wen","year":"2023","journal-title":"Expert Rev. Gastroenterol. Hepatol."},{"key":"ref_32","first-page":"88","article-title":"The value of endoscopic duodenal papilloplasty with titanium clip in improving post-operative complications of choledocholithiasis","volume":"92","author":"Zhao","year":"2024","journal-title":"Cir. Cir."},{"key":"ref_33","first-page":"338","article-title":"The effect of pre-operative biliary drainage in resectable periampullary lesions: A systematic review and meta-analysis","volume":"92","author":"Li","year":"2024","journal-title":"Cir. Cir."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4532\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:59:09Z","timestamp":1760032749000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4532"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,26]]},"references-count":33,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14134532"],"URL":"https:\/\/doi.org\/10.3390\/jcm14134532","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,26]]}}}