title: Does prophylactic endoscopic sphincterotomy prevent recurrent biliary problems in patients with gallstones and a normal cholangiogram?
abstract: BACKGROUND
  Endoscopic sphincterotomy (ES) is indicated in patients with confirmed bile duct stones at endoscopic retrograde cholangiopancreatography (ERCP). The role of ES in patients with suspected bile duct stones but a normal cholangiogram, in the prevention of recurrent biliary symptoms, when cholecystectomy is not planned, is unclear.
  
  
  OBJECTIVE
  To determine if prophylactic ES prevents further biliary problems in such patients.
  
  
  METHODS
  Patients were identified with gallbladder stones presenting with jaundice, abnormal liver function tests (LFTs) or dilated bile ducts on ultrasound, in whom cholecystectomy was not planned and who had a normal cholangiogram at ERCP. Patients were followed-up to determine the frequency of recurrent biliary problems or repeat investigations.
  
  
  RESULTS
  Forty-one patients were included, of whom 20 had an ES. The frequency of pre-ERCP features did not differ between the two groups. Median follow-up was 32 months (range 15-66). Post-ERCP recurrent abdominal pain (5 vs 3; p=0.39), jaundice (3 vs 1; p=0.28), pancreatitis (0 vs 1; p=0.32), and repeat ultrasound (2 vs 1; p=0.52), ERCP (1 vs 1; p=0.97) or cholecystectomy (2 vs 3, p=0.82) did not differ between the two groups.
  
  
  CONCLUSIONS
  Patients with gallstones, suspected common bile duct (CBD) stones and a normal cholangiogram need not have a prophylactic sphincterotomy since there is no reduction in recurrent biliary problems and this potentially increases the morbidity.
authors.affiliation: Division of Gastroenterology, Ulster Hospital, Belfast, Northern Ireland. simon.johnston@bch.n-i.nhs.uk
authors.forename: S D
authors.initials: SD
authors.lastname: Johnston
authors.forename: P
authors.initials: P
authors.lastname: Lim
authors.forename: J S A
authors.initials: JS
authors.lastname: Collins
authors.forename: R G P
authors.initials: RG
authors.lastname: Watson
authors.forename: T C K
authors.initials: TC
authors.lastname: Tham
mesh_terms: D000368:Aged; D002758:Cholangiography; D002769:Cholelithiasis / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D012008:Recurrence; D016717:Sphincterotomy, Endoscopic; D013997:Time Factors