RESULTS OF ENDOSCOPIC SPHINCTEROTOMY IN COMMON BILE-DUCT STONES

  • 1 January 1985
    • journal article
    • research article
    • Vol. 9  (1) , 51-55
Abstract
Endoscopic sphincterotomy (ES) was attempted in 409 patients with common bile duct stone(s) (CBDS). The mean age of patients was 72.0 .+-. 0.8 yr; 47% presented risk factors; 57% had previously been cholecystectomized while 43% had not. On an average, patients in the former group were older (80 .+-. 0.7 yr) than in the latter (65.4 .+-. 1.0 yr; P < 0.001). The procedure was successful in 98% of the patients, after a standard ES in 78.5% or after different technical artifices in 21.5%. The vacuity of the CBD was obtained in 96.5% of the cases. During the 1st mo. after the ES, 13% of the patients had complications and 4% died; 37 complications (9%) were related to the ES and were responsible for death in 4 patients; 18 episodes of bleeding at the site of ES, 7 acute pancreatitis, 6 cholangitis, 4 retroperitoneal perforations and 2 other complications. The occurrence of these complications was closely related to the technique of ES being more frequent after technical artifices than after a standard ES (P < 0.001). These complications occurred independently of the age of patients or of previous cholecystectomy; 17 complications (4%) did not depend directly on ES and were responsible for death in 14 patients (3%): pneumopathy, pulmonary embolism. Their prevalence was related to the age of patients (P < 0.05). Follow-up information was obtained from 349 patients who had a successful ES and were not operated on thereafter and who were still alive 1 mo. after ES. The mean follow-up period was 19 .+-. 1 mo. (1-93 mo.) Biliary and pancreatic complications occurred in 26 patients (7.5%): 16 cholangitis with CBDS, 3 stenosis of the CBD at the site of ES, 2 cholangitis without CBDS, 5 acute cholecystitis and 3 other complications. Half of the complications appeared < 1 yr after the ES. Their occurrence was attached to the presence of the gallbladder (P < 0.05); 42 patients (12%) died from causes not related to CBDS or ES. Death was more frequent among the older patients and those who had risk factors. ES is an efficient procedure for the treatment of CBDS and the associated risks are small.