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


METHODS
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.
Pereira-Lima
J C
JC
Department of Gastroenterology, Biliary Endoscopy Unit, Santa Casa University Hospital, Porto Alegre School of Medical Sciences (FFFCMPA), Porto Alegre, Brazil. jpereiralima@zaz.com.br
Rynkowski
C B
CB
Rhoden
E L
EL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D042882:Gallstones / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000401:mortality; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D016717:Sphincterotomy, Endoscopic; D015996:Survival Rate; D016896:Treatment Outcome