Choledocholithiasis in cirrhotic patients: is endoscopic sphincterotomy the safest choice?

Of the 18 endoscopic sphincterotomies performed on 18 cirrhotic patients for choledocholithiasis, a mortality rate of 16.6% was registered. However, this figure can be limited to 6.6% if we take only successful sphincterotomies (15/18, 83.3%) into account. After closely reviewing relevant literature, it would appear that operative mortality in comparable cases is much higher. We therefore recommend that endoscopic sphincterotomy, despite higher mortality rates when compared to the general population, should be the initial choice of management of choledocholithiasis in cirrhotic patients.