Long‐term Prognosis of Patients After Endoscopic Sphincterotomy for Choledocholithiasis

Abstract

EST for choledocholithiasis is safe and effective. Cholecystectomy after EST is recommended in patients with calculous GB, but is not necessary in patients with acalculous GB. Pneumobilia was associated with the recurrence of choledocholithiasis.

Prognostic Factors and Postoperative Recurrence of Calculus Following Small-Incision Sphincterotomy with Papillary Balloon Dilation for the Treatment of Intractable Choledocholithiasis: A 72-Month Follow-Up Study

“…However, the long-term recurrence rate in the EST group (6.9 %) was significantly higher than that in the EST-EPBD group (1.36 %, P \ 0.05). In addition, the overall recurrence rate in the EST-EPBD group (9.52 %) was lower than that in EST group (20.1 %), which is consistent with the rate of long-term complications reported by studies in Japan with 8-and 10-year follow-up periods [20,21]. Furthermore, our logistic regression analysis showed that serum level of cholesterol and body mass index were significant risk factors for the recurrence of common bile duct stones and that gallstones, stone size, and the number of stones were also associated with the recurrence of ductal stones.…”

Japan Gastroenterological Endoscopy Society guidelines for endoscopic sphincterotomy

“…reported that during the mean observation period of 6.7 years, the cumulative incidence of biliary complications was significantly higher in the EST group and that the rate of recurrence was 17% in the EST group and 7.9% in the EPBD group, with results significantly higher in the EST group compared to the EPBD group. Although there are few reports of repeated recurrence, it has been found that recurrence of two times or more is seen in 1.5% to 2.8% of patients . It is thought that recurrence is greatly affected by duodenobiliary reflux associated with biliary sphincter dysfunction following EST and, thus, risk factors for recurrence include findings of intrabiliary edema, large‐sized bile duct, presence of gallbladder stones, periampullary diverticulum, and the use of a mechanical lithotripter …”

Evidence-based clinical practice guidelines for cholelithiasis 2016

“…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.…”