M Sugiyama1, Y Atomi. 1. First Department of Surgery, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
Abstract
BACKGROUND: With the advent of laparoscopic cholecystectomy, the indications for endoscopic sphincterotomy (ES) have been extended to young patients with choledocholithiasis. However, the long-term results of ES are largely unknown. METHODS: Between 1977 and 1986, 115 patients aged 60 years or less underwent ES for choledocholithiasis. Stone classification, and early and long-term outcomes of ES were analysed retrospectively. RESULTS: Early complications occurred in nine patients (7.8 per cent), but there were no deaths. ES and stone clearance were successful in 110 patients. Long-term information was available in 103 of the 110 patients, with a mean overall follow-up duration of 14-2 (range 10.4-19.3) years. Ten patients (9.7 per cent) developed late complications, including stone recurrence and/or cholangitis (nine patients) and acute cholecystitis (one of 23 patients with the gallbladder in situ). The choledochal complication rate was somewhat higher in patients with calcium bilirubinate stones at ES (seven of 65 patients) than in those with cholesterol stones (two of 38 patients). Choledochal complications were manageable endoscopically. CONCLUSION: Approximately 10 per cent of patients develop late complications. However, endoscopic retreatment is safe and effective. ES is a reasonable method for treating choledocholithiasis, even in young patients.
BACKGROUND: With the advent of laparoscopic cholecystectomy, the indications for endoscopic sphincterotomy (ES) have been extended to young patients with choledocholithiasis. However, the long-term results of ES are largely unknown. METHODS: Between 1977 and 1986, 115 patients aged 60 years or less underwent ES for choledocholithiasis. Stone classification, and early and long-term outcomes of ES were analysed retrospectively. RESULTS: Early complications occurred in nine patients (7.8 per cent), but there were no deaths. ES and stone clearance were successful in 110 patients. Long-term information was available in 103 of the 110 patients, with a mean overall follow-up duration of 14-2 (range 10.4-19.3) years. Ten patients (9.7 per cent) developed late complications, including stone recurrence and/or cholangitis (nine patients) and acute cholecystitis (one of 23 patients with the gallbladder in situ). The choledochal complication rate was somewhat higher in patients with calcium bilirubinate stones at ES (seven of 65 patients) than in those with cholesterol stones (two of 38 patients). Choledochal complications were manageable endoscopically. CONCLUSION: Approximately 10 per cent of patients develop late complications. However, endoscopic retreatment is safe and effective. ES is a reasonable method for treating choledocholithiasis, even in young patients.
Authors: Byoung Wook Bang; Seok Jeong; Don Haeng Lee; Jung Il Lee; Jin-Woo Lee; Kye Sook Kwon; Hyung Gil Kim; Yong Woon Shin; Young Soo Kim Journal: Korean J Intern Med Date: 2010-08-31 Impact factor: 2.884