Outcomes of endoscopic sphincterotomy vs open choledochotomy for common bile duct stones

Abstract

BACKGROUNDEndoscopic sphincterotomy (EST) for the management of common bile duct stones (CBDS) is used increasingly widely because it is a minimally invasive procedure. However, some clinical practitioners argued that EST may be complicated by post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and accompanied by a higher recurrence of CBDS than open choledochotomy (OCT). Whether any differences in outcomes exist between these two approaches for treating CBDS has not been thoroughly elucidated to date.AIMTo compare the outcomes of EST vs OCT for the management of CBDS and to clarify the risk factors associated with stone recurrence.METHODSPatients who underwent EST or OCT for CBDS between January 2010 and December 2012 were enrolled in this retrospective study. Follow-up data were obtained through telephone or by searching the medical records. Statistical analysis was carried out for 302 patients who had a follow-up period of at least 5 years or had a recurrence. Propensity score matching (1:1) was performed to adjust for clinical differences. A logistic regression model was used to identify potential risk factors for recurrence, and a receiver operating characteristic (ROC) curve was generated for qualifying independent risk factors.RESULTSIn total, 302 patients undergoing successful EST (n = 168) or OCT (n = 134) were enrolled in the study and were followed for a median of 6.3 years. After propensity score matching, 176 patients remained, and all covariates were balanced. EST was associated with significantly shorter time to relieving biliary obstruction, anesthetic duration, procedure time, and hospital stay than OCT (P < 0.001). The number of complete stone clearance sessions increased significantly in the EST group (P = 0.009). The overall incidence of complications and mortality did not differ significantly between the two groups. Recurrent CBDS occurred in 18.8% (33/176) of the patients overall, but no difference was found between the EST (20.5%, 18/88) and OCT (17.0%, 15/88) groups. Factors associated with CBDS recurrence included common bile duct (CBD) diameter > 15 mm (OR = 2.72; 95%CI: 1.26-5.87; P = 0.011), multiple CBDS (OR = 5.09; 95%CI: 2.58-10.07; P < 0.001), and distal CBD angle ≤ 145° (OR = 2.92; 95%CI: 1.54-5.55; P = 0.001). The prediction model incorporating these factors demonstrated an area under the receiver operating characteristic curve of 0.81 (95%CI: 0.76-0.87).CONCLUSIONEST is superior to OCT with regard to time to biliary obstruction relief, anesthetic duration, procedure time, and hospital stay and is not associated with an increased recurrence rate or mortality compared with OCT in the management of CBDS.

Advances in Risk Factors for Recurrence of Common Bile Duct Stones

“…However, there is little data on whether there is a difference between the two methods in the treatment of CBDS. Zhou et al (98) concluded that compared with OCT, EST was superior to OCT in terms of duration of relief of biliary obstruction, duration of anesthesia, duration of surgery, and hospitalization days. However, there was no significant difference between OCT and EST in the recurrence and mortality of choledocholithiasis.…”

Recurrence of common bile duct stones following laparoscopic common bile duct exploration: a multicenter study

“…Laparoscopic common bile duct exploration (LCBDE) and open choledochotomy (OCT) are usually indicated when patients are suspected of having cancer or removal of CBDS when ERCP has failed . LCBDE has a shorter hospital length of stay than OCT or two‐stage treatment (ERCP and cholecystectomy) .…”

Medium and long-term complications difference between laparoscopic transcystic common bile duct exploration versus endoscopic sphincterotomy against choledocholithiasis

“…Minimally invasive treatment of CBDS has the advantages of safety, quick recovery, less pain, and less economic burden. LCBDE and EST [ 17 ] are the main minimally invasive operation for the treatment of CBDS, and the curative effect is satisfactory. However, there is no consensus on the medium and long-term complication difference between the 2 operations.…”

“…[ 12 , 13 ] Both EST and LTCBDE could effectively treat CBDS with high success rates. [ 14 , 15 ] However, there are few studies about the differences of medium and long-term complications after EST or LTCBDE. Therefore, we will conduct a meta-analysis and systematic review to systematically evaluate the difference of medium and long-term complications between EST and LTCBDE against CBDS.…”