Long-term Follow-up after Endoscopic Sphincterotomy (EST)

Summary

Long-term results after endoscopic sphincterotomy (EST) revealed disappearance or improvement of symptoms in 92.0 %. The symptoms remained unchanged in 6.2 % and deteriorated in only 1.8 %. X-ray follow-up studies showed concrement-free bile ducts in 85.2 %, recurrent stones in 11.3 %, and a stenosis of EST in 3.5 %.

Satisfactory long-term results depend on the indication for EST. The results of EST for choledocholithiasis are much better than for papillary stenosis (symptom-free or improved = 91.7 %: 83.7 %, unchanged = 6.4 %: 14.3 %, deteriorated = 1.9 %: 2.0 %). An EST-related stenosis was more than five times more frequent (16.8 %:2.9 %) in papillary stenosis than choledocholithiasis.

A gallbladder in situ does not seem to be an additional risk factor after EST. Subsequent cholecystectomy was performed in only 16.2 % (routinely and elective), and in only 2.0 % as an emergency procedure.

In approximately 50 % of the cases aerobilia and reflux, and in about 100 % bacteriocholia, are observed after EST. When the free outflow of bile is ensured, it is not probable that late secondary diseases will develop.

Key words:

Endoscopy - Sphincterotomy - Choledocholithiasis