DUODENOSCOPIC SPHINCTEROTOMY FOR REMOVAL OF BILE-DUCT STONES IN PATIENTS WITH GALLBLADDERS

  • 1 January 1982
    • journal article
    • research article
    • Vol. 91  (6) , 628-630
Abstract
Duodenoscopic sphincterotomy was attempted in 71 elderly patients with gallbladders who presented with acute symptoms caused by common bile duct stones. Sphincterotomy was possible in all but 1 patient and duct clearance was achieved in 61 (86%); failures were usually due to the size of the stones. Two patients required blood transfusions for immediate bleeding and 2 underwent cholecystectomy for acute cholecystitis developing within 7 days of sphincterotomy. One patient with a retained stone was judged to be unfit for surgery and died 6 wk after sphincterotomy. Eleven patients had elective cholecystectomy. Forty-eight patients (mean age 75 yr) were discharged with their gallbladders in place; clinical follow-up (mean 19 mo.) was possible in 44. None have suffered cholangitis or jaundice and only 5 have so far needed cholecystctomy for recurrent biliary pains. Duodenoscopic sphincterotomy is recommended for acutely ill patients with symptoms caused by duct stones, even patients with gallbladders. Longer follow-up is required to judge the indications for subsequent cholecystectomy, but present evidence suggests that it is reasonable to postpone cholecystectomy indefinitely for many elderly and frail patients.