title: Do patients with recurrent choledocholithiasis after endoscopic sphincterotomy benefit from regular follow-up?
abstract: BACKGROUND
  As many as 24% of patients who undergo endoscopic sphincterotomy for the removal of bile duct stones have recurrent biliary complications develop for which there is no effective method of prevention. The aim of this study was to determine whether patients who undergo routine clinical follow-up after endoscopic sphincterotomy for bile duct stones have a different outcome than those who do not.
  
  
  METHODS
  All patients who had endoscopic sphincterotomy for bile duct stones were scheduled for follow-up visits, liver function tests, and transabdominal US every 3 to 6 months. ERCP was performed whenever symptoms recurred, or abnormal liver function or US was noted. The patients themselves decided whether to adhere to the follow-up schedule; this was not a randomized trial.
  
  
  RESULTS
  Seven hundred sixty-seven patients underwent endoscopic sphincterotomy for bile duct stones from October 1990 to July 1999. Seventy-seven (10%) were found to have recurrent bile duct stones. Three patients who had undergone Billroth II gastrectomy were excluded. Among the remaining 74 patients (52 men, 22 women; mean age 65 years), 42 (57%) had a juxtapapillary diverticulum and 21 (28%) an intact gallbladder. The mean time to recurrence of bile duct stones was 19.7 months (range 5-72 months). Sixty-four patients (87%) had recurrent bile duct stones within 3 years. Fifty-one (69%) were followed regularly (Group A) and 23 (31%) were not (Group B). At the time of stone recurrence, 20 patients in Group A (39%) and 1 in Group B (4%) were asymptomatic (p = 0.002). Liver function tests were normal in 17 patients (13 Group A, 4 Group B). Endoscopic treatment for recurrent bile duct stones was successful in 46 patients (90%) in Group A and 16 (70%) in Group B (p = 0.04); surgical treatment was successful in all 5 patients in Group A and 4 of the 7 patients in Group B. Two patients in Group B were treated by nasobiliary drainage and biliary endoprosthesis insertion caused by extremely large stones and poor condition; both died (acute pancreatitis and sepsis).
  
  
  CONCLUSIONS
  Regular follow-up after endoscopic sphincterotomy detects recurrent bile duct stones early and thus avoids complications of bile duct stones.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, National Yang Ming University, Taiwan, Republic of China.
authors.forename: Kwok-Hung
authors.initials: KH
authors.lastname: Lai
authors.forename: Gin-Ho
authors.initials: GH
authors.lastname: Lo
authors.forename: Chiun-Ku
authors.initials: CK
authors.lastname: Lin
authors.forename: Ping-I
authors.initials: PI
authors.lastname: Hsu
authors.forename: Hoi-Hung
authors.initials: HH
authors.lastname: Chan
authors.forename: Jin-Shiung
authors.initials: JS
authors.lastname: Cheng
authors.forename: E-Ming
authors.initials: EM
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care; D005260:Female; D042882:Gallstones / Q000517:prevention & control* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016717:Sphincterotomy, Endoscopic; D017211:Treatment Failure