Endoscopic papillotomy in patients with gallbladder in situ. Is subsequent cholecystectomy necessary?

Endoscopic papillotomy was performed for choledocholithiasis in 22 high-risk patients with gallbladder in situ. The procedure was well tolerated by the patients and was performed without serious complications. Pathologic laboratory findings normalized in most cases during the first week after papillotomy. The median hospital stay was four days. Laparotomy was subsequently performed in five cases, in one because of impaction of a 3 cm stone two days after the papillotomy, and in four because of biliary symptoms during a five-year follow-up period. On the basis of experience with this patient series and recent reports in the literature, primary endoscopic papillotomy is recommended as the sole therapeutic procedure for high-risk patients.