title: Randomised trial of endoscopic sphincterotomy with gallbladder left in situ versus open surgery for common bileduct calculi in high-risk patients.
abstract: BACKGROUND
  Morbidity and mortality after surgical treatment of bileduct stones increase with age and associated diseases. A proposed alternative therapy is endoscopic sphincterotomy (ES) with the gallbladder left in situ, and we elected to compare this option with standard open surgery in high-risk patients.
  
  
  METHODS
  98 patients (mean age 80 years) with symptoms likely to be due to bileduct stones or a recent episode of biliary pancreatitis were randomised to be treated either by open cholecystectomy with operative cholangiography and (if necessary) bileduct exploration (n=48) or by endoscopic sphincterotomy alone (n=50).
  
  
  RESULTS
  The procedure was accomplished successfully in 94% of the surgery group and 88% of the ES group, and there were no significant differences in immediate morbidity (23% vs 16%) or mortality (4% vs 6%). During mean follow-up of 17 months biliary symptoms recurred in three surgical patients, none of whom underwent repeat surgery, and in 10 ES patients, seven of whom had biliary surgery. By multivariate regression analysis endoscopic sphincterotomy was an independent predictor of recurrent biliary symptoms (odds ratio 6.9; 95% Cl 1.46 to 32.54).
  
  
  CONCLUSIONS
  In elderly or high-risk patients, surgery is preferable to endoscopic sphincterotomy with the gallbladder left in situ as a definitive treatment for bileduct stones or non-severe biliary pancreatitis.
authors.affiliation: Service of General and Digestive Surgery, Hospital Clinic, University of Barcelona, Spain.
authors.forename: E M
authors.initials: EM
authors.lastname: Targarona
authors.forename: R M
authors.initials: RM
authors.lastname: Ayuso
authors.forename: J M
authors.initials: JM
authors.lastname: Bordas
authors.forename: E
authors.initials: E
authors.lastname: Ros
authors.forename: I
authors.initials: I
authors.lastname: Pros
authors.forename: J
authors.initials: J
authors.lastname: Martínez
authors.forename: J
authors.initials: J
authors.lastname: Terés
authors.forename: M
authors.initials: M
authors.lastname: Trías
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000453:epidemiology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy; D005260:Female; D005500:Follow-Up Studies; D005704:Gallbladder; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010359:Patient Readmission; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence; D012306:Risk; D016717:Sphincterotomy, Endoscopic / Q000379:methods*