Endoscopic sphincterotomy for bile duct stones in patients with intact gallbladders

Abstract

Endoscopic sphincterotomy was performed in 121 patients (age ranged 34-92 years; median 80 years) with intact gallbladders and bile duct stones. Clearance of the duct by basket or balloon extraction was attempted in 97 patients (80 per cent) and achieved in 93 of these patients (96 per cent). In 24 patients the duct was left to empty spontaneously and this occurred in 22 patients. Immediate complications due to endoscopic sphincterotomy occurred in five patients (two haemorrhage, two perforation, one haemorrhage and perforation). Of the 101 patients reviewed 12-72 months (median 24 months) after endoscopic sphincterotomy, 76 (75 per cent) have remained asymptomatic throughout the follow-up period. Eighteen patients (18 per cent) required cholecystectomy for recurrent gallbladder symptoms 1-24 months after endoscopic sphincterotomy. One of the asymptomatic patients underwent cholecystectomy on the advice of his consultant. A further seven had recurrent biliary colic or cholangitis necessitating enlargement of the sphincterotomy and further stone retrieval in three of these patients. Endoscopic sphincterotomy is an effective treatment for bile duct stones in high risk patients, but subsequent cholecystectomy is required in a significant number of patients owing to continuing gallbladder symptoms.

Endoscopic sphincterotomy for prevention of the recurrence of acute biliary pancreatitis in patients with gallbladder in situ: long-term follow-up of 88 patients

“…On the other hand, in patients with gallbladder in situ undergoing ES due to gallstones in the common bile duct, symptoms of biliary origin recur in 4-21% of cases, with =15% of these requiring an open operation [9,17,28,33,35,40,43,46]. It is interesting to note that a recent randomized study [5] found a 47% rate of recurrent biliary symptoms, with 37% of these patients undergoing cholecystectomy for this reason.…”

Are complications of endoscopic sphincterotomy age related?

“…Between 75% and 90% of all patients undergoing endoscopic sphincterotomy will remain asymptomatic up to 15 years after the procedure 1419 Recurrence of biliary stones occurs in 10% of patients while reintervention for stenosis may be required in around 3% 1417 19 Recurrent stones can be successfully treated by repeat sphincterotomy in 90% of cases.…”

“…19 Recurrence of biliary stones occurs in 10% of patients while reintervention for stenosis may be required in around 3% 1417 19 Recurrent stones can be successfully treated by repeat sphincterotomy in 90% of cases. Although this study did not assess long term complications, serious consequences of endoscopic sphincterotomy are sufficiently uncommon to make significant long term problems in young patients unlikely.…”

General surgery

“…They make a strong case, which many would agree with, for emergency colonoscopy being the first choice examination in any patient with massive lower gastrointestinal bleeding. Trudel et al 6 described very similar results in their series in which diagnosis was established in 50% of patients and in 28 patients treated by endoscopic coagulation, 68% were controlled.…”