Endoscopic treatment of choledocholithiasis in the era of laparoscopic cholecystectomy: prospective analysis of 386 patients.

Abstract

BACKGROUND/AIMS:

Endoscopic papillotomy is a well-established procedure for treating choledocholithiasis. The aim of this study is to expose our experience with this method in a prospectively collected series of 386 patients and to analyze the safety and efficacy of the pre-cut procedure.

METHODOLOGY:

Between October 1995 and December 1999, 760 endoscopic retrograde cholangiopancreatographies were performed in 670 patients. Of these, 449 were done to treat 386 patients with choledocholithiasis. The pre-cut technique was performed after failure of multiple cannulation attempts.

RESULTS:

Bile duct clearance was achieved in 344 (89.1%) cases, however the success rate would increase to 95.1%, if the cases, which endoscopic stone extraction was not feasible, were excluded. Pre-cut was performed in 31 (8.03%) patients, and 11 of them presented some procedure-related complication, while the complication rate of standard sphincterotomy was 3.9% (relative risk = 8.4; 95% confidence interval = 4.2-16.7). Overall complication rate was 6.7% (26 out of 386)--pancreatitis = 13, bleeding = 9, acute cholecystitis = 2, cholangitis = 1, guide-wire-related choledochal perforation = 1. Thirty-day mortality was 1.55% (n = 6), but procedure-related mortality was 0.25% (n = 1).

CONCLUSIONS:

Endoscopic papillotomy is a safe and effective procedure for patients with symptomatic choledocholithiasis. The pre-cut procedure increases the complication rate of the endoscopic approach, and should be restricted to cases, in which an endoscopic intervention is mandatory.

• Authors: J C Pereira-Lima, C B Rynkowski, E L Rhoden
• Journal: Hepato-gastroenterology (Hepatogastroenterology) 2001 Sep-Oct Vol. 48 Issue 41 Pg. 1271-4 ISSN: 0172-6390 [Print] Greece
• PMID: 11677944 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Female
• Gallstones (mortality, surgery)
• Humans
• Intraoperative Complications (etiology, mortality)
• Laparoscopy
• Male
• Middle Aged
• Postoperative Complications (etiology, mortality)
• Prospective Studies
• Sphincterotomy, Endoscopic
• Survival Rate
• Treatment Outcome