Study of common bile duct exploration and endoscopic sphincterotomy in a consecutive series of 438 patients

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Abstract
The outcome of 438 consecutive patients who had exploration of the common bile duct and/or endoscopic sphincterotomy (ES) in a 5‐year period was reviewed. Patients were analysed according to four groups: 59 patients had planned ES followed by surgery resulting in 14 major complications (23·7 per cent) including 3 deaths (5·1 per cent) (group 1); 248 patients had surgery alone with 21 major complications (8·5 per cent) including 10 deaths (4·0 per cent) (group 2); 114 patients with gallbladder in situ underwent ES alone with 22 major complications (19·3 per cent) including 9 deaths (7·9 per cent) (group 3); 17 patients with remote cholecystectomy also had ES alone with 3 major complications (17·6 per cent) including 3 deaths (17·6 per cent) (group 4). There was no difference in mortality between the groups. Compared with group 2, major complications were significantly higher in group 1 (χ2 = 11·0, d.f. = 1, P2 = 8·6, d.f. = 1, P<0·003). Patients in group 3, however, were significantly older than those in groups 1 and 2, and the former also had higher medical and total risk factor scores than the latter (all P<0·001). The results indicate that routine pre‐operative ES is of que: ionable value. ES alone is justified in elderly high risk patients; mortality in this group might be reduced by improved management of post‐ES complications.