Surgical Versus Endoscopie Management of Common Bile Duct Stones

Abstract

The charts of all patients with common bile duct (CBD) stones admitted to Virginia Mason Medical Center between January 1, 1981 and July 31, 1986 were reviewed to define current methods of management and results of operative versus endoscopic therapy. Two hundred thirty-seven patients with CBD stones were treated. One hundred thirty patients had intact gallbladders. Of these patients, 76 (59%) underwent cholecystectomy and common bile duct exploration (CBDE) while 54 (41%) underwent endoscopic papillotomy (EP) only. Of the 107 patients admitted with recurrent stones after cholecystectomy, all but five were treated with EP. The overall mortality rate was 3.0%. Complications, success, and death rates were all similar for CBDE and EP, but the complications of EP were often serious and directly related to the procedure (GI hemorrhage, 6; duodenal perforation, 5; biliary sepsis, 4; pancreatitis, 1). Patients undergoing EP required significantly shorter hospitalization than those undergoing CBDE. Multivariate analysis showed that age greater than 70 years, technical failure, and complications increased the risk of death, regardless of procedure performed. Twenty-one per cent of those undergoing EP with gallbladders intact eventually required cholecystectomy. The conclusion is that the results of EP and CBDE are similar, and the use of EP has not reduced the mortality rates of this disease.

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] . In addition, it permanently destroys the biliary sphincter, which can lead to chronic complications, such as duodenal biliary reflux, bacterial contamination, and chronic inflammation of the biliary system [11] .…”

Endoscopic sphincterotomy with or without cholecystectomy for choledocholithiasis in high‐risk surgical patients: a decision analysis

“…It should be noted that the biliary complication rate in the wait-and-see group (47%) was significantly higher when compared with other similar trials. Several other trials [28][29][30] 16%). During mean follow-up of 17 months, the probability whether patients being free of biliary symptoms was higher in the ES + LC group than in the ES-alone group (85% and 61%, respectively).…”

Use of Rigid Nephroscope in Open Common Bile Duct Exploration - Our Experience

“…It has been reported that CBD stone clearance rate of traditional open CBDE is 83.3% to 88.8%. 22,23 Our experience with the use of rigid scope is very encouraging and seems to be safe and highly effective.…”