Endoscopic Sphincterotomy: Long-term Results in 408 Patients with Complete Follow-up

Abstract

Endoscopic sphincterotomy was performed in 469 patients for the treatment of biliary calculi, with procedure-related morbidity of 6.3% and mortality of 0.4%. Long-term follow-up to 10.5 years (mean 3.7 years) was completed in all of 408 patients at least six months postsphincterotomy. Recurrent stones developed in 21 patients (5.8%) after a mean of 2.4 years (range 4 months to 7 years); in 6 after 3 years. Eight patients reformed stones more than twice at a mean interval of 1.8 years (range, 5 months to 3.5 years). In the 122 patients with gallbladders in situ, acute cholecystitis occurred in 5 of 31 with gallstones (16%), but in none of the 91 without gallstones. In the 237 patients who had undergone cholecystectomy, 4 late deaths occurred secondary to recurrent choledocholithiasis and cholangitis. In the 49 patients with primary intrahepatic stones, 3 late deaths occurred secondary to hepatic abscess. These results suggest that (a) endoscopic sphincterotomy is a very effective procedure in long-term follow-up, (b) cholangiography should be done at the appearance of slight abdominal symptoms even after 3 years, (c) patients who have ever reformed stones should undergo cholangiography yearly for at least 4 years, and (d) cholecystectomy is recommended for patients with gallbladders after sphincterotomy, only if gallstones are present.

Small sphincterotomy combined with endoscopic papillary large balloon dilation versus sphincterotomy

“…Its success rate exceeds 90%, and it has been accepted as the best nonsurgical treatment for common bile duct stones [29][30][31][32][33] . However, EST is still associated with an 8%-12% rate of acute complications, such as bleeding, perforation, cholangitis, and post-procedure pancreatitis [11,25,[34][35][36][37] .…”

Evidence-based clinical practice guidelines for cholelithiasis 2016

“…In negative history of biliary reconstruction, transpapillary endoscopic treatment is indicated for patients without bile duct strictures. However, no studies with a large number of participants were conducted to assess transpapillary endoscopic treatment of hepatolithiasis without choledocholithiasis, and most reports described concurrent choledocholithiasis [212][213][214]. Tanaka et al [212] conducted EST in 57 patients with concurrent hepatolithiasis and choledocholithiasis and reported that the stones were completely removed in 24 patients (42.1%), including three patients with spontaneous stone passage.…”

Tendencies and outcomes in endoscopic biliary sphincterotomies among people with or without type 2 diabetes mellitus in Spain, 2003-2013

“…It has therefore had a widespread acceptance for decades (1,2). On the one hand, it is possible that advancing technology and overall improved quality of medical care allow for better outcomes, but on the other hand, more aggressive approaches in the elderly and in those patients with higher numbers of medical coexisting conditions might confer a worse prognosis.…”