The Role of Endoscopic Sphincterotomy in Management of Recurrent Common Bile Duct Stones

Abstract

In this study, the role of endoscopic sphincterotomy (EST) in the management of recurrent common bile duct (CBD) stones after cholecystectomy was assessed in 131 patients who were admitted to the Veterans General Hospital-Taipei from May 1985 to July 1992. Successful sphincterotomy with CBD stone extraction was achieved in 105 (94.6%) of the 111 patients who received endoscopic treatment. The remaining 20 patients, including 17 patients who were not indicated for EST and three patients who refused EST, received exploratory choledocholithotomies. The success and complication rate in the treatment of patients with CBD stones showed no significant difference between the two groups. The occurrence of complications in the EST group was related to the procedure (papillary hemorrhage, 8; cholangitis, 2; and pancreatitis, 1). Hemostasis by means of an endoscopic injection was achieved in 87.5% of the patients with papillary bleeding. A single mortality (0.9%) was related to postoperative respiratory distress which occurred in a patient with EST failure. In the surgical group, a patient complicated with postoperative biliary leakage required a second operation. Patients who underwent endoscopic treatment required a shorter period of hospitalization than those in the surgical group (7.0±4.9 vs. 14±11.4 days). The follow-up results of 85 (81%) patients during an average period of 13.9±12.2 months after EST showed that 84.7% (72/85) of the patients remained symptom-free. The late complications were recurrence of CBD stones in 8.2% (7/85), acalculous cholangitis in 4.7% (4/85), and papillary stenosis in 2.4% (2/85) of the patients. We concluded that EST is highly effective in the management of recurrent CBD stones. However, surgery should be reserved for the treatment of CBD stones when technical and anatomical factors limit the use of endoscopic method. Prior screening for clinical factors in individual patients for the appropriate method of management should be required.