title: Does cholecystectomy after endoscopic sphincterotomy prevent the recurrence of biliary complications?
abstract: BACKGROUND
  The intact gallbladder after endoscopic sphincterotomy is thought to be a potential risk factor for recurrent biliary complications. The aim of this non-randomized prospective study was to investigate whether cholecystectomy soon after endoscopic sphincterotomy could prevent the recurrence of biliary complications.
  
  
  METHODS
  From January 1991 to October 1995, 140 patients with intact gallbladder underwent endoscopic sphincterotomy for clearance of stones in the bile duct. Of the 140 patients, 46 underwent elective cholecystectomy soon after sphincterotomy (group A) and 94 did not (group B). All 140 patients had quantitative cholescintigraphy after normalization of liver function and were followed on a regular basis with liver biochemistry, sonography, and/or computed tomography. Endoscopic retrograde cholangiography was also performed if a recurrent biliary problem was suspected.
  
  
  RESULTS
  After a median 43 months (range 23 to 80) of follow-up, 5 patients in group A developed bile duct stones whereas 12 patients in group B had recurrent stones; 4 patients in group A versus 6 patients in group B had recurrent biliary symptoms. One patient in group A and 5 patients in group B with recurrent biliary stones were without symptoms. In group B, the age, gender, diameter of the bile duct, preexisting cholelithiasis, abnormal filling of the gallbladder on quantitative cholescintigraphy, and presence of juxtapapillary diverticulum were not found to be the significant factors affecting the recurrence of biliary symptoms or stones. Endoscopic removal of recurrent biliary stones was successful in all patients. Three patients in group B underwent cholecystectomy after abatement of symptoms.
  
  
  CONCLUSIONS
  Elective cholecystectomy after endoscopic sphincterotomy does not reduce the incidence of recurrent biliary complications.
authors: Department of Internal Medicine, Veterans General Hospital Kaohsiung, National Yang Ming University, Taiwan, Republic of China.
authors: K H
authors: KH
authors: Lai
authors: L F
authors: LF
authors: Lin
authors: G H
authors: GH
authors: Lo
authors: J S
authors: JS
authors: Cheng
authors: R L
authors: RL
authors: Huang
authors: C K
authors: CK
authors: Lin
authors: J S
authors: JS
authors: Huang
authors: P I
authors: PI
authors: Hsu
authors: N J
authors: NJ
authors: Peng
authors: L P
authors: LP
authors: Ger
mesh_terms: D000368:Aged; D001649:Bile Duct Diseases / Q000453:epidemiology / Q000517:prevention & control; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000453:epidemiology / Q000517:prevention & control*; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic; D013997:Time Factors