Late Complications following Endoscopic Sphincterotomy for Choledocholithiasis: A Swedish Population-Based Study.

A Langerth,A Ekbom,L Brandt,B.-M Karlson

doi:10.1155/2014/745790

Abstract

In order to assess the risk of long-term complications following endoscopic sphincterotomy (ES) for common bile duct stones (CBDS), we conducted a cohort study. The study included 1,113 patients who underwent ES for CBDS in six different hospitals in central Sweden between 1977 and 1990. Through the use of the Swedish population registry, each patient was assigned five population-based controls matched for sex and age. Linkage to the Inpatient Registry yielded information on morbidity and mortality for the patients as well as for the controls. After one year of washout, there were 964 patients available for follow-up. The mean age was 70.6 years, 57% were women, and the mean length of follow-up was 8.9 years. The patients' overall morbidity was significantly higher and we observed a tendency towards increased mortality as well. Recurrent CBDS was diagnosed in 4.1% of the patients. Acute cholangitis with a hazard ratio (HR) of 36 (95%CI 11–119.4) was associated with recurrent CBDS in 39% of the patients. HR for acute pancreatitis was 6.2 (95%CI 3.4–11.3) and only one patient had CBDS at the same time. In conclusion, we consider acute pancreatitis and cholangitis both as probable long-term complications after ES.

Highlights

Long-term results after endoscopic sphincterotomy (ES) have been the topic of several studies, with a complication rate, including recurrent common bile duct stones (CBDS), between 5 and 24%
After exclusion of the first year, the overall morbidity as well as mortality after ES was significantly increased as compared to the background population
We found a significantly higher mortality after ES in both men (HR 1.29 (95%CI 1.05–1.59)) and women (HR 1.30 (95%CI 1.06–1.60)) in the 65–79 age group and for men younger than 50 (HR 3.22 (95%CI 1.22–8.48)) compared to the background population (Table 3)

Summary

Introduction

Long-term results after endoscopic sphincterotomy (ES) have been the topic of several studies, with a complication rate, including recurrent common bile duct stones (CBDS), between 5 and 24%. Some of the studies include reports of acute cholangitis together with CBDS, but it was not until 1996 that Prat et al [7] described “sine materia cholangitis.”. The mean follow-up was 9.6 years and three out of 154 patients (1.9%) developed acute cholangitis without recurrent CBDS. In a more recent study by Costamagna et al [4], with 458 patients and a mean follow-up of 6.8 years, four of the 458 patients (0.9%) had a diagnosis “sine materia cholangitis.”. Some authors report no cases of acute cholangitis without concurrent CBDS [1, 2, 9].

Methods

Results

Conclusion