[Endoscopic sphincterotomy in choledocholithiasis: analysis of an experience of 530 interventions].
We report the experience of 530 consecutive cases of choledocolithiasis treated through Endoscopic Sphincterotomy (ES) between January 1980 and January 1988 (74% of total patients submitted to ES in the same period). 73% had more than 60 years and 47% more than 70 years. A slight majority (52%) had previous cholecystectomy (1/3 still with T-tube drainage) and the remaining had gallbladders insitu (lithiasic in 82%). Therapeutic goals (achieved drainage and complete stone removal) have been achieved in 95% of patients with a low immediate morbidity (9%) and mortality (1%). Delayed mortality, until 30th day (3%) includes 6 cases of obstructive cholangitis with sepsis, unaltered by emergent ES. Follow-up showed a 3% incidence of reintervention from restenosed ES. Patients with lithiasic gallbladder had a 33% cholecistectomy rate, mostly elective during first month post-ES. Our experience confirms ES as an efficient and safe routine treatment for choledocolithiasis. It should be the first choice in patients with previous cholecystectomy or alithiasic gallbladder and a largely applicable tool in those with associated gallbladder stones. Decision about post-ES cholecystectomy in these patients must be weighed on clinical grounds and according to surgical risk groups.
Ginestal-Cruz
A
A
Serviço de Medicina 2, Hospital de Santa Maria/Faculdade de Medicina de Lisboa.
Grima
N
N
Correia
A P
AP
Duarte
V
V
Correia
J P
JP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002758:Cholangiography; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013105:Sphincterotomy, Transduodenal
Esfincterotomia endoscópica na coledocolitíase: análise de uma experiência de 530 intervenções.