Endoscopic sphincterotomy versus surgery in treatment of choledocholithiasis concomitant with liver cirrhosis

Abstract

Objective To compare the therapeutic efficacy and procedure related complications between endoscopic sphincterotomy （EST） and surgery in treatment for choledocholithiasis concomitant with liver cirrhosis. Methods The data of patients with choledocholithiasis concomitant with cirrhosis who underwent EST （n = 139） or surgery （n =98） for stone clearance from August 1985 to May 2008, were retrospectively analyzed and compared. Results The success rates of complete stone clearance in EST and surgery groups were 95% and 100% , respectively. There was a significant difference in the rate of procedure-related complications between EST and surgery groups （ 16. 5% vs. 62. 2% , P 〈0. 01 ）, as well as the mortality rate （5.0% vs. 24. 5% ）. When patients were further grouped according to Child-Pugh liver function classification, a siguifieant difference in rate of procedure-related complications was detected between 2 groups in patients of Child-Pugh B and C, as well as the mortality rate in patients of Child-Pugh C. Conclusion For patients with choledocholithiasis concomitant with liver cirrhosis, EST, with a stone clearance rate at 95% , is superior to surgery with a significant reduction in risk of procedure-related complication and mortality rate. Key words: Liver cirrhosis ; Choledocholithiasis ; Endoscopic sphincterotomy ; Surgical procedures