Endoscopic papillosphincterotomy and surgical sphincteroplasty for the treatment of bile duct stones: a comparative analysis.
One hundred and ten subjects with cholelithiasis entered this retrospective study. Early and late results of 73 patients treated by endoscopic papillosphincterotomy (EPST) were compared to those of 37 patients who had surgical transduodenal papillo-sphincteroplasty (SST). The comparative analysis was made in terms of clinical, biochemical and ultrasonographic findings. The follow-up period ranged from 1 to 5 years in the first group and from 1 to 15 years in the second group. EPST and SST proved to be comparable in regard to operative mortality and morbidity. EPST failed in removing large or impacted bile duct stones in 47% of cases, while SST was uniformly successful. Long-term results were good in most patients, either when treated by EPST or SST. The 5-year failure rate was 8% after EPST and 0% after SST. In the surgical group, the 15-year failure rate was 5%. Serum alkaline phosphatase levels were higher after EPST than after SST, suggesting the persistence of some degree of biliary stasis in endoscopically managed patients. Pneumobilia was detected more often in surgical patients, indicating that SST does create a wide and permanent communication between the duodenum and the biliary system.


CONCLUSIONS
1) EPST may achieve acceptable success rates with low mortality and morbidity, even in high risk patients; 2) the high number of long-term good clinical results seems to indicate that sphincter re-stenosis after EPST is rare, at least for the first 5 years from operation; 3) SST is an effective and safe procedure, ensuring excellent long-term results, provided that the technique of and the indication for are correct (including Wirsung assessment); 4) the wide and permanent stoma created by SST is not associated with recurrent cholangitis, if bile duct re-stenosis does not occur.
Motta
G
G
Semeiotica Chirurgica 1, Università di Genova.
Ratto
G B
GB
Barone
D
D
Pugliese
V
V
Aste
H
H
Gianquinto
D
D
D014670:Ampulla of Vater / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D009803:Sphincter of Oddi / Q000601:surgery*; D013105:Sphincterotomy, Transduodenal; D014463:Ultrasonography