Long-term follow-up of patients after endoscopic sphincterotomy for choledocholithiasis, and risk factors for recurrence.
OBJECTIVE
There have been growing concerns about the long-term sequelae of endoscopic sphincterotomy (ES). The aims of the study were to evaluate the long-term clinical outcome of ES for choledocholithiasis and to identify the predictors of recurrence.


METHODS
A total of 529 patients (233 men, 296 women; mean age 63, range 9 - 88) who underwent successful ES for choledocholithiasis were evaluated. Follow-up data were obtained retrospectively. Statistical analyses were carried out for 334 patients who had a follow-up of at least 5 years or had recurrence.


RESULTS
Immediate complications occurred in 37 patients (7 %). Follow-up data were available in 458 patients (86.6 %), of whom 280 (61.1 %) were asymptomatic, 127 (27.7 %) died from unrelated causes without recurrence, and 51 (11.1 %) had biliary symptoms and/or choledocholithiasis recurrence. Most recurrences (65 %) occurred more than 2 years following ES and were observed on multiple occasions in 13 patients (2.8 %). A bile duct diameter of 22 mm or greater was found to predict recurrence. Of 190 patients with an intact gallbladder, 11 (5.8 %) developed acute cholecystitis necessitating emergency cholecystectomy; all of these had previously documented gallstones.


CONCLUSIONS
Endoscopic sphincterotomy for choledocholithiasis is found to be safe at long-term follow-up. A dilated bile duct (> or = 22 mm) is a marker for patients at increased risk of recurrence of symptoms and/or choledocholithiasis.
Costamagna
G
G
Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, A. Gemelli University Hospital, Rome, Italy. gcostamagna@rm.unicatt.it
Tringali
A
A
Shah
S K
SK
Mutignani
M
M
Zuccalà
G
G
Perri
V
V
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D066298:In Vitro Techniques; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D011336:Probability; D012008:Recurrence; D018570:Risk Assessment; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects* / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome