Background and Study Aims: There have been growing concerns about the long-term sequelae of endoscopic sphincterotomy (ES). The aims of the study were to evaluate the long-term clinical outcome of ES for choledocholithiasis and to identify the predictors of recurrence.
Patients and Methods: A total of 529 patients (233 men, 296 women; mean age 63, range 9 - 88) who underwent successful ES for choledocholithiasis were evaluated. Follow-up data were obtained retrospectively. Statistical analyses were carried out for 334 patients who had a follow-up of at least 5 years or had recurrence.
Results: Immediate complications occurred in 37 patients (7 %). Follow-up data were available in 458 patients (86.6 %), of whom 280 (61.1 %) were asymptomatic, 127 (27.7 %) died from unrelated causes without recurrence, and 51 (11.1 %) had biliary symptoms and/or choledocholithiasis recurrence. Most recurrences (65 %) occurred more than 2 years following ES and were observed on multiple occasions in 13 patients (2.8 %). A bile duct diameter of 22 mm or greater was found to predict recurrence. Of 190 patients with an intact gallbladder, 11 (5.8 %) developed acute cholecystitis necessitating emergency cholecystectomy; all of these had previously documented gallstones.
Conclusions: Endoscopic sphincterotomy for choledocholithiasis is found to be safe at long-term follow-up. A dilated bile duct (≥ 22 mm) is a marker for patients at increased risk of recurrence of symptoms and/or choledocholithiasis.
References
-
1
Tham T CK, Carr-Locke D L, Collins J SA.
Endoscopic sphincterotomy in the young patient: is there cause for concern?.
Gut.
1997;
40
697-700
-
2
Ingoldby C JH, El-Saadi J, Hall R I. et al .
Late results of endoscopic sphincterotomy for bile duct stones in elderly patients with gallbladders in situ.
Gut.
1989;
30
1129-1131
-
3
Hammarstrom L E, Holmin T, Stridbeck H. et al .
Long-term follow-up of a prospective randomized study of endoscopic versus surgical treatment of bile duct calculi in patients with gallbladder in situ.
Br J Surg.
1995;
82
1516-1521
-
4
Targarona E M, Ayuso R M, Bordas J M. et al .
Randomised trial of endoscopic sphincterotomy with gallbladder left in situ versus open surgery for common bile duct calculi in high-risk patients.
Lancet.
1996;
347
926-929
-
5
Frimberger E.
Long-term sequelae of endoscopic papillotomy.
Endoscopy.
1998;
30 (Suppl. 2)
A221-227
-
6
Freeman M L, Nelson D B, Sherman S. et al .
Complications of endoscopic biliary sphincterotomy.
N Engl J Med.
1996;
335
909-918
-
7
Cotton P B, Lehman G, Vennes J. et al .
Endoscopic sphincterotomy complications and their management: an attempt at consensus.
Gastrointest Endosc.
1991;
37
383-393
-
8
Saito M, Tsuyuguchi T, Yamaguchi T. et al .
Long-term outcome of endoscopic papillotomy for choledocholithiasis with cholecystolithiasis.
Gastrointest Endosc.
2000;
51
540-545
-
9
Kullman E, Borch K, Dahlin L G. et al .
Long-term follow-up with gallbladder in situ after endoscopic sphincterotomy for choledocholithiasis.
Eur J Surg.
1991;
157
131-135
-
10
Hill J, Martin D F, Tweedle D EF.
Risks of leaving the gallbladder in situ after endoscopic sphincterotomy for bile duct stones.
Br J Surg.
1991;
78
554-557
-
11
Pereira-Lima J C, Jakobs R, Winter U H. et al .
Long-term results (7 to 10 years) of endoscopic papillotomy for choledocholithiasis. Multivariate analysis of prognostic factors for the recurrence of biliary symptoms.
Gastrointest Endosc.
1998;
48
457-464
-
12
Yi S Y.
Recurrence of biliary symptoms after endoscopic sphincterotomy for choledocholithiasis in patients with gallbladder stones.
J Gastroenterol Hepatol.
2000;
15
661-664
-
13
Hansell D T, Millar M A, Murray W R. et al .
Endoscopic sphincterotomy for bile duct stones in patients with intact gallbladders.
Br J Surg.
1989;
76
856-858
-
14 Hand D J. Linear discriminant analysis. In: Armitage P, Colton T (eds) Encyclopedia of Biostatistics. West Sussex; Wiley 1998: 1168-1179
-
15
Hammarström L-E, Holmin T, Stridbeck H.
Endoscopic treatment of bile duct calculi in patients with gallbladder in situ. Long-term outcome and factors predictive of recurrent symptoms.
Scand J Gastroenterol.
1996;
31
294-301
-
16
Ikeda S, Tanaka M, Matsumoto S. et al .
Endoscopic sphincterotomy: long-term results in 408 patients with complete follow-up.
Endoscopy.
1988;
20
13-17
-
17
Hawes R H, Cotton P B, Vallon A G.
Follow-up 6 to 11 years after duodenoscopic sphincterotomy for stones in patients with prior cholecystectomy.
Gastroenterology.
1990;
98
1008-1012
-
18
Tanaka M, Takahata S, Konomi H. et al .
Long-term consequence of endoscopic sphincterotomy for bile duct stones.
Gastrointest Endosc.
1998;
48
465-469
-
19
Prat F, Malak N A, Pelletier G. et al .
Biliary symptoms and complications more than 8 years after endoscopic sphincterotomy for choledocholithiasis.
Gastroenterology.
1996;
110
894-899
-
20
Escourrou J, Cordova J A, Lazorthes F. et al .
Early and late complications after endoscopic sphincterotomy for biliary lithiasis with and without the gallbladder in situ.
Gut.
1984;
25
598-602
-
21
Sugiyama M, Atomi Y.
Follow-up more than 10 years after endoscopic sphincterotomy for choledocholithiasis in young patients.
Br J Surg.
1998;
85
917-921
-
22
Geenen J E, Toouli J, Hogan W J. et al .
Endoscopic sphincterotomy: follow-up evaluation of effects on the sphincter of Oddi.
Gastroenterology.
1984;
87
754-758
-
23
Jacobsen O, Matzen P.
Long-term follow-up study of patients after endoscopic sphincterotomy for choledocholithiasis.
Scand J Gastroenterol.
1987;
22
903-906
-
24
Kullman E, Borch K, Liedberg G.
Long-term follow-up after endoscopic management of retained and recurrent common duct stones.
Acta Chir Scand.
1989;
155
395-399
-
25
Geenen D J, Geenen J E, Jafri F M. et al .
The role of surveillance endoscopic retrograde cholangiopancreatography in preventing episodic cholangitis in patients with recurrent common bile duct stones.
Endoscopy.
1998;
30
18-20
-
26
Seifert E.
Long-term follow-up after endoscopic sphincterotomy.
Endoscopy.
1988;
20
232-235
-
27
Lai K H, Lin L F, Lo G H. et al .
Does cholecystectomy after endoscopic sphincterotomy prevent the recurrence of biliary complications?.
Gastrointest Endosc.
1999;
49
483-487
-
28
Hagège H, Berson A, Pelletier G. et al .
Association of juxtapapillary diverticula with choledocholithiasis but not with cholecystolithiasis.
Endoscopy.
1992;
24
248-251
-
29
Hammarström L-E, Stridbeck H, Ihse I.
Long-term follow-up after endoscopic treatment of bile duct calculi in cholecystectomized patients.
World J Surg.
1996;
20
272-276
-
30
Mcsherry C K, Ferstenberg H, Calhoun F. et al .
The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients.
Ann Surg.
1985;
202
59-64
-
31
Siegel J H, Safrany L, Ben-Zvi J S. et al .
Duodenoscopic sphincterotomy in patients with gallbladders in situ: report of a series of 1272 patients.
Am J Gastroenterol.
1988;
83
1255-1258
-
32
Davidson B R, Neoptolemos J P, Carr-Locke D L.
Endoscopic sphincterotomy for common bile duct calculi in patients with gall bladder in situ considered unfit for surgery.
Gut.
1988;
29
114-120
-
33
Rosseland A R, Solhaug J H.
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.
World J Surg.
1988;
12
111-116
-
34
Desa L A, Grace P A, Vipond M N. et al .
Gallbladder function after endoscopic sphincterotomy.
Br Med J.
1990;
300
1111
-
35
Teilum D, Ravnborg L.
Sphincter of Oddi and filling of the gallbladder. A necropsy study.
Endoscopy.
1989;
21
131-132
-
36
Sharma B C, Agarwal D K, Baijal S S. et al .
Effect of endoscopic sphincterotomy on gallbladder bile lithogenicity and motility.
Gut.
1998;
42
288-292
-
37
Tham T CK, Kennedy R, O'Connor F A.
Early complications and mean 8-year follow-up after endoscopic sphincterotomy in young fit patients.
Eur J Gastroenterol Hepatol.
1994;
6
621-624
-
38
Bergman J J, van der Mey S, Rauws E A. et al .
Long-term follow-up after endoscopic sphincterotomy for bile duct stones in patients younger than 60 years of age.
Gastrointest Endosc.
1996;
44
643-649
-
39
Pedersen F M, Lassen A T, Schaffalitzky de Muckadell O B.
Endoscopic sphincterotomy for common bile duct stones in younger patients.
Dan Med Bull.
1998;
45
533-535
G. Costamagna, M.D.
Digestive Endoscopy Unit · “A. Gemelli” University Hospital
Largo A. Gemelli 8 · 00168 Rome · Italy
Fax: + 39-06-35511515
Email: gcostamagna@rm.unicatt.it
