Long‐Term Follow‐up after Endoscopic Treatment of Bile Duct Calculi in Cholecystectomized Patients

Hammarström, Lars-Erik; Stridbeck, H.; Ihse, Ingemar

doi:10.1007/s002689900043

Cited by 25 publications

(15 citation statements)

References 40 publications

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“…In contrast, other groups report reflux of duodenal secretion into bile ducts and presence of bacteria in the bile duct system in 70% of cases [27], and significant biliary symptomatology in 15% of patients [9,29]. Tranter and Thompson reported a late development of bile duct cancer in up to two per cent of patients following EPT, possibly based on the chronic mucosal inflammation [30].…”

Section: Discussionmentioning

confidence: 77%

Laparoscopic management of common bile duct stones

Ebner¹,

Rechner²,

Beller³

et al. 2004

Surg Endosc

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Section: Discussionmentioning

confidence: 77%

Laparoscopic management of common bile duct stones

Ebner¹,

Rechner²,

Beller³

et al. 2004

Surg Endosc

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“…Successful ES and complete stone removal are achieved in 86–98% and 73–97%, respectively [34, 35]. These excellent results are reportedly accompanied by a low complication rate of 4.4–10.4% and a low mortality rate of 0.4–1.5% [1, 2, 33].…”

Section: Introductionmentioning

confidence: 79%

Endoscopic Management of Common Bile Duct Stones Leaving the Gallbladder in situ

et al. 2004

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Background: Obstructive jaundice caused by stones is a common disorder, mostly managed by endoscopic sphincterotomy followed by cholecystectomy. The aim of this study was to evaluate whether or not clearance of the common bile duct alone is sufficient as treatment for patients with choledocholithiasis. Methods: A cohort with 447 patients with symptomatic cholecystocholedocholithiasis, undergoing endoscopic retrograde cholangiography (ERC) and if necessary sphincterotomy (ES). In 164 patients common bile duct stones were proven and treated endoscopically, without performing a subsequent cholecystectomy. All 164 patients were free of symptoms after the endoscopic intervention. This group of patients was compared with 78 patients who underwent cholecystectomy after endoscopic treatment of common bile duct stones. Patients were followed for 1–13 years after ERC and sphincterotomy results and complications were registered. Results: The ages of the 164 patients in the in situ group were significantly higher than in the cholecystectomy group and the ASA classification (American Society of Anesthesiologists) was significantly higher in the in situ patients. Mean follow-up was 70.9 months. Of the in situ patients 27 (16%) returned with biliary symptoms; 12 with common bile duct stones, three with cholangitis, and one with stenosis of Vater’s papilla. Eight patients returned with cholecystitis and 3 with symptomatic cholecystolithiasis. Thirteen patients underwent cholecystectomy and 11 were managed (also) endoscopically. Minor complications were 2 wound infections and 1 bleeding after cholecystectomy. Two patients (1%) died of abdominal sepsis due to cholecystitis. Of the patients who underwent cholecystectomy, 6 (7.6%) returned during follow-up. Three patients had common bile duct stones, 2 had cholangitis and 1 patient presented with papillostenosis. Three patients needed surgical common bile duct exploration and the other 3 were treated endoscopically. After reintervention, cardiopulmonary complications were observed in 1 patient. There was no related death. Conclusion: When common bile duct stones are treated successfully by endoscopic sphincterotomy and patients are free of symptoms, there is no need for routine prophylactic cholecystectomy.

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“…[9][10][11][12][14][15][16][17][18][19][20] However, the recurrence rate of CBD stones has been in the range of 4-24%. [1][2][3][4][5][6] Furthermore, most recurrences occur within the first 2 or 3 years 6,[9][10][11]13 after stone removal and 39-54% of the patients with recurrent stones are asymptomatic. 8,10,13 In the present study, the recurrence rate of CBD stone was 38% (24 of 63 patients), which was higher than that reported in most other studies.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Many risk factors for the recurrence of CBD stones such as CBD dilatation, acute CBD angulation, periampullary diverticulum (PAD), a history of cholecystectomy and the number of CBD stones have been reported. [5][6][7][8][9][10][11][12] The early detection and treatment of recurrent CBD stones may help to avoid more serious complication such as acute suppurative cholangitis.…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of Early Scheduled Follow-Up Endoscopic Retrograde Cholangiopancreatography after Common Bile Duct Stone Removal

Kim

Lee²,

Jung³

et al. 2011

Gut Liver

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Background/Aims: To investigate the effi cacy of early scheduled follow-up endoscopic retrograde cholangiopancreatography (ERCP) after common bile duct (CBD) stone removal. Methods: Patients who underwent endoscopic CBD stone removal and who had at least one risk factor for stone recurrence were enrolled. Six months after complete clearance of the CBD, patients underwent follow-up ERCP at an ambulatory care center, irrespective of symptoms. Results: The incidence of symptoms and cholangitis at follow-up ERCP was signifi cantly lower in Group A (ERCP at 6 months after stone removal) than that in Group B (ERCP at >6 months) (14.3% vs 71.4%, p=0.00; 9.5% vs 33.3%, p=0.02, respectively). However, the recurrence rates of CBD stones were not different between Groups A and B (33.3% vs 47.6%). When comparing the subgroups, Group AR (stone recurrence in Group A) displayed signifi cantly fewer symptoms and lesser cholangitis and spent fewer days in the hospital than did Group BR (stone recurrence in Group B) (21.4% vs 70%, p=0.02; 14.3% vs 60%, p=0.02; 2.43±1.87 vs 6.10±3.35, p=0.00, respectively). Conclusions: Our data suggest that, irrespective of symptoms, early scheduled follow-up ERCP for patients who are at a high risk of recurrence is effective and safe. (Gut Liver 2011;5:65-69) Key Words: Risk factor; Recurrence; Common bile duct stone; Endoscopic retrograde cholangiopancreatography; Cholangitis INTRODUCTIONThe recurrence rates of common bile duct (CBD) stones after endoscopic stone removal have been reported to range from 4% to 24%. [1][2][3][4][5][6] Many risk factors for the recurrence of CBD stones such as CBD dilatation, acute CBD angulation, periampullary diverticulum (PAD), a history of cholecystectomy and the number of CBD stones have been reported. [5][6][7][8][9][10][11][12] The early detection and treatment of recurrent CBD stones may help to avoid more serious complication such as acute suppurative cholangitis. Several studies [8][9][10]13 have reported that regular clinical follow-up of patients after CBD stones removal is beneficial and it reduces the morbidity related to stone recurrence. However, early detection of CBD stone is not easy even after physical examinations, biochemical tests and ultrasonography. Furthermore, the majority of patients who are without risk factors for recurrence will have no further recurrence after stone removal. Therefore, if followup evaluations are restricted to the patients who are at a high risk for recurrence, then the cost of subsequent examinations may be reduced. In addition, if early scheduled follow-up endoscopic retrograde cholangiopancreatography (ERCP) is more accurate to detect stones and it is safer and feasible for removing the recurrent CBD stone as compared with regular clinical follow-up, then it should be the modality of choice to follow-up the patients who are at a high risk for recurrence. So, we conducted a prospective study on patients who are at a high risk for recurrence to evaluate the efficacy of early scheduled follow-up ERCP after CBD ...

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Long‐Term Follow‐up after Endoscopic Treatment of Bile Duct Calculi in Cholecystectomized Patients

Cited by 25 publications

References 40 publications

Laparoscopic management of common bile duct stones

Laparoscopic management of common bile duct stones

Endoscopic Management of Common Bile Duct Stones Leaving the Gallbladder in situ

The Efficacy of Early Scheduled Follow-Up Endoscopic Retrograde Cholangiopancreatography after Common Bile Duct Stone Removal

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