Background:The long term outcome of endoscopic papillotomy (EPT) is not well known. The aims of this study were to clarify the clinical course of post-EPT patients and to detect predictors for bile duct stone recurrence. Methods: A total of 1042 consecutive patients who underwent EPT for bile duct stones from December 1975 to September 1998 were prospectively followed up. Patients were divided into four groups according to gall bladder (GB) status: "acalculous GB" group, "calculous GB" group, "cholecystectomy" group, and "prior cholecystectomy" group. Reliable follow up information was obtained for 983 (94.3%) of the 1042 patients. The following factors were considered in the evaluation of predisposing risk factors for recurrence of bile duct stones: age, sex, gall bladder status, periampullary diverticulum, number of bile duct stones, diameter of bile duct stones, diameter of bile duct, lithotripsy, precutting, pneumobilia, and early complications. Results: Recurrence occurred in 111 patients. The "acalculous GB" group was less prone to recurrence than the "prior cholecystectomy" group and the "calculous GB" group. The relative risks (RR) for the latter two compared with the former group were 2.26 (95% confidence interval (CI) 1.24-4.14; p=0.0078) and 2.16 (95% CI 1.21-3.87; p=0.0093), respectively. Other prognostic factors were lithotripsy (RR 2.37; 95% CI 1.47-3.81; p=0.0004) and pneumobilia (RR 1.57; 95% CI 1.01-2.43; p=0.044). Conclusions: Gall bladder status, lithotripsy, and pneumobilia were significantly related to bile duct stone recurrence after EPT.

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Pancreatitis is the most common and serious complication of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP), and hyperamylasemia after ERCP is common. The aim of the present study was to examine the potential patient-and procedure-related risk factors for post-ERCP pancreatitis including hyperenzymenia in a prospective study. Data were collected prospectively on patient characteristics and endoscopic techniques from 184 ERCP performed at a single referral center and entered into a database. Data were collected prior to the procedure, at the time of procedure, and 24-72 h after procedure. The primary end-point was the incidence of post-ERCP pancreatitis and the secondary objective was the incidence of hyperamylasemia. Of the 184 patients enrolled, diagnostic ERCP was performed in 37 (20.1%) and therapeutic ERCP in 147 (79.9%). Pancreatitis developed in two patients (1.1%) and was graded mild in one (0.5%) and severe in the other (0.5%). Hyperamylasemia occurred in 14 patients (7.6%). Six investigated variables, female gender, therapeutic ERCP, major papilla sphincterotomy, stenting, difficult cannulation, and bile duct diameter were not significant risk factors for post-ERCP pancreatitis. Although there was no significant factors in pancreatitis, the number of cannulations and precut sphincterotomies were significantly related to hyperamylasemia. The present study emphasizes a technical factor (difficult cannulation) as the determining high-risk predictors for post-ERCP pancreatitis.