Long‐term Outcome of Endoscopic Papillotomy for Choledocholithiasis With Cholecystolithiasis

Fujimoto, Tatsuya; Tsuyuguchi, Toshio; Sakai, Yuji; Sugiyama, Harutoshi; Miyakawa, Kaoru; Eto, Reiko; Yasui, Shin; Ishihara, Takeshi; Yokosuka, Osamu

doi:10.1111/j.1443-1661.2010.00936.x

Cited by 31 publications

(35 citation statements)

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“…Some authors have identified bile duct size >15 mm as a risk factor for recurrent stones 18,21,32. A dilated CBD is likely to lead to bile stasis and bacterial infection, which play central roles in the mechanism of stone formation 20,24,33. There are some possibilities of small fragmented stones missed by cholangiogram in patients with a large bile duct.…”

Section: Discussionmentioning

confidence: 99%

Recurrence of Bile Duct Stones after Endoscopic Papillary Large Balloon Dilation Combined with Limited Sphincterotomy: Long-Term Follow-Up Study

Kim¹,

Rhu²,

Kim³

2012

Gut Liver

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Background/AimsEndoscopic papillary large-balloon dilation combined with limited endoscopic sphincterotomy (EPLBD+ES) is promising for the treatment of common bile duct (CBD) stones. The aim of this study was to clarify the recurrence rate and the risk factors for CBD stones after EPLBD+ES.MethodsIn total, 100 patients who underwent EPLBD+ES from 2006 to 2007 were evaluated retrospectively. One hundred and nine patients who were treated with endoscopic sphincterotomy (ES) from 2004 to 2005 were set as the historical control group. Various risk factors for the recurrence of bile duct stones were analyzed.ResultsOf the 209 patients, the duration of follow-up was 32.5±4.5 months in the EPLBD+ES group and 31.8±6.0 months in the ES group. The recurrence rate of CBD stones was 11.0% (11/100) in the EPLBD+ES group and 13.8% (15/109) in the ES group (p=0.546). The cumulative recurrence rate of stones was not significantly different between the EPLBD+ES and ES groups (log rank, p=0.537). Univariate analysis showed that the diameter of the CBD (≥22 mm) was the only predictive variable that could differentiate recurrence from nonrecurrence in the EPLBD+ES group. Multivariate analysis revealed that the diameter of the bile duct was the only risk factor for stone recurrence (p=0.022; odds ratio, 1.175; 95% confidence interval, 1.023 to 1.348).ConclusionsThe recurrence rate of CBD stones after EPLBD+ES is comparable to that of the ES group, and a dilated CBD appears to increase the risk of bile duct stone recurrence.

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Section: Discussionmentioning

confidence: 99%

Recurrence of Bile Duct Stones after Endoscopic Papillary Large Balloon Dilation Combined with Limited Sphincterotomy: Long-Term Follow-Up Study

Kim¹,

Rhu²,

Kim³

2012

Gut Liver

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“…However, as deaths from causes unrelated to gallstones were included, there may have been selection bias related to patient variables. A post-EST cohort study found that pneumobilia increased the risk of complications in gallbladder-preserved cases, but no data on the risk of death were shown [165,166]. Although not removing the gallbladder after EST is clearly associated with gallstonerelated complications in the long term, it remains unknown whether this is associated with increased mortality.…”

Section: Commentarymentioning

confidence: 99%

Evidence-based clinical practice guidelines for cholelithiasis 2016

Tazuma

Unno²,

Igarashi³

et al. 2016

J Gastroenterol

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213

178

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Cholelithiasis is one of the commonest diseases in gastroenterology. Remarkable improvements in therapeutic modalities for cholelithiasis and its complications are evident. The Japanese Society of Gastroenterology has revised the evidence-based clinical practice guidelines for cholelithiasis. Forty-three clinical questions, for four categories-epidemiology and pathogenesis, diagnosis, treatments, and prognosis and complications-were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This article preferentially describes the clinical management of cholelithiasis and its complications. Following description of the diagnosis performed stepwise through imaging modalities, treatments of cholecystolithiasis, choledocholithiasis, and hepatolithiasis are introduced along with a flowchart. Since there have been remarkable improvements in endoscopic treatments and surgical techniques, the guidelines ensure flexibility in choices according to the actual clinical environment. The revised clinical practice guidelines are appropriate for use by clinicians in their daily practice.

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“…Also, the long-term outcome of EST has been of concern 9,10. Fujimoto et al 11. followed up 522 patients who received EST due to choledocholithiasis and cholelithiasis for 5.6 years.…”

Section: Discussionmentioning

confidence: 99%

“…However, the results of comparative studies are controversial 5,6. Furthermore, EST causes early and late complications, such as pancreatitis, perforation, bleeding, permanent loss of sphincter Oddi function, bacterial translocation in the bile duct, and recurrence of biliary colic 7–11…”

Section: Introductionmentioning

confidence: 99%

The Role of Endoscopic Biliary Drainage without Sphincterotomy in Gallstone Patients with Cholangitis and Suspected Common Bile Duct Stones Not Detected by Cholangiogram or Intraductal Ultrasonography

et al. 2017

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Background/AimsTreatment for cholangitis without common bile duct (CBD) stones has not been established in patients with gallstones. We investigated the usefulness of endoscopic biliary drainage (EBD) without endoscopic sphincterotomy (EST) in patients diagnosed with gallstones and cholangitis without CBD stones by endoscopic retrograde cholangiopancreatography (ERCP) and intraductal ultrasonography (IDUS).MethodsEBD using 5F plastic stents without EST was performed prospectively in patients with gallstones and cholangitis if CBD stones were not diagnosed by ERCP and IDUS. After ERCP, all patients underwent laparoscopic cholecystectomy. The primary outcomes were clinical and technical success. The secondary outcomes were recurrence rate of biliary events and procedure-related adverse events.ResultsAmong 187 patients with gallstones and cholangitis, 27 patients without CBD stones according to ERCP and IDUS received EBD using 5F plastic stents without EST. The stents were maintained in all patients until laparoscopic cholecystectomy, and recurrence of cholangitis was not observed. After cholecystectomy, the stents were removed spontaneously in 12 patients and endoscopically in 15 patients. Recurrence of CBD stones was not detected during the follow-up period (median, 421 days).ConclusionsEBD using 5F plastic stents without EST may be safe and effective for the management of cholangitis accompanied by gallstones in patients without CBD stones according to ERCP and IDUS.

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Long‐term Outcome of Endoscopic Papillotomy for Choledocholithiasis With Cholecystolithiasis

Abstract: Pneumobilia was the only significant risk factor for cholecystitis and recurrent choledocholithiasis in our study population. As for the long-term outcome, it was unclear whether endoscopic papillotomy contributed to the occurrence of biliary tract cancer.

Cited by 31 publications

References 25 publications

Recurrence of Bile Duct Stones after Endoscopic Papillary Large Balloon Dilation Combined with Limited Sphincterotomy: Long-Term Follow-Up Study

Recurrence of Bile Duct Stones after Endoscopic Papillary Large Balloon Dilation Combined with Limited Sphincterotomy: Long-Term Follow-Up Study

Evidence-based clinical practice guidelines for cholelithiasis 2016

The Role of Endoscopic Biliary Drainage without Sphincterotomy in Gallstone Patients with Cholangitis and Suspected Common Bile Duct Stones Not Detected by Cholangiogram or Intraductal Ultrasonography

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