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Endoscopy 2002; 34(4): 273-279
DOI: 10.1055/s-2002-23632
Original Article

© Georg Thieme Verlag Stuttgart · New York

Long-Term Follow-Up of Patients After Endoscopic Sphincterotomy for Choledocholithiasis, and Risk Factors for Recurrence

G.  Costamagna 1 , A.  Tringali 1 , S.  K.  Shah 1 , M.  Mutignani 1 , G.  Zuccalà 2 , V.  Perri 1
  • 1Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, A. Gemelli University Hospital, Rome, Italy
  • 2Dept. of Gerontology, Università Cattolica del Sacro Cuore, A. Gemelli University Hospital, Rome, Italy
Further Information

Publication History

5 April 2001

9 October 2001

Publication Date:
03 April 2002 (online)

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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.

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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