Primary endoscopic papillotomy (EPT) in patients with stones in the common bile duct and the gallbladder in situ: A 5‐8‐year follow‐up study

Abstract

Seventy-five patients (mean age, 77 years) with common duct stones and the gallbladder in situ were treated with primary endoscopic papillotomy (EPT) during the period 1976-1979. The endoscopic procedure was successful in all patients, but 4 patients had to be operated on since the common duct stone did not pass.The complication rate was 13.3% and 1 patient died. One patient was operated on with cholecystectomy within a week after EPT because of progression of his cholecystitis. Another patient was operated on with drainage for perforated liver abscesses and cholecystectomy; she also died 1 week after Operation.In the follow-up period of 5-8 years, 12 patients were operated on with cholecystectomy: 7 patients because of acute cholecystitis, and 3 patients because of recurrent pain attacks. In 2 patients, the operation was done electively.Thirty patients died, all from other diseases except 1 patient who died from a gallbladder carcinoma 1 1/2 years after EPT. Three patients were treated conservatively for acute cholecystitis.After 5 years, 28 patients were still alive with the gallbladder in situ and none had symptoms from the gallbladder. Altogether, 13 (17.3%) patients were treated for acute cholecystitis during the 5-8-year follow-up period.

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.…”

Practice Guidelines in Acute Pancreatitis

“…Some studies have suggested the effectiveness of endoscopic biliary sphincterotomy in these circumstances in preventing further episodes of acute biliary pancreatitis. These uncontrolled case series mostly suggest a reduction in the frequency of attacks of pancreatitis, although recurrent bile duct stones or acute cholecystitis may still be a problem in the future (255)(256)(257)(258)(259)(260)(261)(262)(263)(264). Before considering an empiric biliary sphincterotomy for recurrent pancreatitis with or without abnormal liver function tests, the clinician must be aware of the possibility of an alternative etiology, such as sphincter of Oddi dysfunction, especially in women, young or middleaged patients, and patients who are postcholecystectomy, or do not have clearly documented gallstone disease.…”

Duodenoscopic sphincterotomy for biliary calculi

“…Lately, DS has been used increasingly for CBD stones in patients with intact gallbladder. [70][71][72][73][74][75][76][77] While such patients constituted only 5% of patients undergoing DS in 1981,' they constituted 57-58% in 1984.8. 71 The procedure was employed initially on elderly, frail persons whose symptoms settled with DS and who were left without cholecystectomy in view of their high surgical risk and short expected survival time ( Table 2)…”