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. 2024 Dec 5;13(23):7414.
doi: 10.3390/jcm13237414.

Combinatorial Effects of Terpene, Chenodeoxycholic Acid, and Ursodeoxycholic Acid on Common Bile Duct Stone Recurrence and Gallbladder Stone Dissolution

Min Je Sung  1 , Sung Yong Han  2 , Jong Hyun Lee  2 , Tae In Kim  2 , Dong Uk Kim  2 , Chang-Il Kwon  1 , Jae Hee Cho  3 , Jung Wan Choe  4 , Jong Jin Hyun  4 , Jae Kook Yang  5 , Tae Hoon Lee  5 , Jungnam Lee  6 , Sung Ill Jang  3 , Seok Jeong  6
Affiliations

Combinatorial Effects of Terpene, Chenodeoxycholic Acid, and Ursodeoxycholic Acid on Common Bile Duct Stone Recurrence and Gallbladder Stone Dissolution

Min Je Sung et al. J Clin Med. .

Abstract

Background: Ursodeoxycholic acid (UDCA), chenodeoxycholic acid (CDCA) plus UDCA (C&U), and terpene are widely administered to prevent common bile duct (CBD) stone recurrence and dissolve gallbladder (GB) stones. We evaluated and compared the combined effects of these agents on CBD stone recurrence and GB stone resolution. Methods: This study included patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) at six referral centers, retrospectively. A total of 940 patients who underwent cholecystectomy before or after CBD stone removal by ERCP were evaluated to assess CBD stone recurrence (the CBD recurrence cohort), and 98 patients with GB stones were assessed by abdominal or endoscopic ultrasonography before and 6 months after ERCP to evaluate GB stone resolution (GB cohort). Patients were divided into no-medication, single-agent treatment (UDCA, C&U, or terpene), or dual-agent treatment (terpene plus UDCA or C&U) groups for the analysis. Results: In the CBD recurrence cohort, baseline characteristics were similar in the three groups. CBD stone recurrence rates were 41.5%, 12.7%, and 9.8% in the no-medication, single-agent, and dual-agent groups, respectively (p < 0.001), and the recurrence rate was significantly lower for those administered C&U plus terpene (5.2% vs. 13.2%, p = 0.002). In the GB cohort, baseline characteristics were also similar in the groups. GB stone resolution rates of >30% were observed in 5.3%, 14.3%, and 34.8% of patients in the no-medication, single-agent, and dual-agent groups, respectively (p = 0.028). Conclusions: C&U plus terpene was significantly more effective for preventing CBD stone recurrence and achieving GB stone resolution than no medication or single agents.

Keywords: choledocholithiasis; cholelithiasis; recurrence.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Factors associated with common bile duct stone recurrence. The no-medication group had a significantly higher cumulative recurrence rate than the single-agent or dual-agent groups (p < 0.001). However, no significant difference was observed between the two groups at 6 months.
Figure 3
Figure 3
Kaplan–Meier curves for common bile duct stone recurrence. Recurrence rates did not differ significantly between the single-agent group and the dual-agent group (p = 0.085).
Figure 4
Figure 4
Kaplan–Meier curves for common bile duct stone recurrence. Compared to the other medication groups, the chenodeoxycholic acid and ursodeoxycholic acid (C&U) plus terpene group had significantly lower cumulative recurrence rates (p = 0.034).
Figure 5
Figure 5
Gallbladder stone resolution by medication group and stone type. Percentage changes in stone size are shown for patients in (a) the no-medication group, (b) the dual-agent group, and (c) the single-agent group. Complete stone resolution was achieved in 7 patients (12.5%) in the single-agent group and 5 patients (21.7%) in the dual-agent group.
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