title: Long-term prognosis of patients after endoscopic sphincterotomy for choledocholithiasis.
abstract: BACKGROUND
  The aims of the present study were to clarify the long-term prognosis of endoscopic sphincterotomy (EST) for choledocholithiasis and to evaluate the need for cholecystectomy after EST.
  
  
  METHODS
  Between 1993 and 2007, 262 patients who underwent successful EST for choledocholithiasis were followed up for more than 6 months). Eighteen patients had previously undergone cholecystectomy (Group A), 129 had a calculous gallbladder (GB) and underwent cholecystectomy after EST (Group B), 46 had a calculous GB in situ (Group C), and 69 had an acalculous GB in situ (Group D). Late complications, including recurrence of choledocholithiasis, acute cholecystitis and biliary carcinoma, were evaluated.
  
  
  RESULTS
  Of the 262 patients, late complications occurred in 34 patients (13.0%) and recurrence of choledocholithiasis occurred in 29 patients (11.1%). The rate of late complications was higher in Group C (23.9%) than in Group B (7.8%) (P < 0.001). The rate of recurrent choledocholithiasis was higher in Group C (17.4%) than in Group B (7.8%) (P < 0.05). Univariate analysis indicated that pneumobilia after EST was associated with the recurrence of choledocholithiasis (P < 0.001). Acute cholecystitis occurred in eight (7.0%) of 115 patients with intact GB. A gallbladder carcinoma was found after EST. Late complications were not serious and endoscopically or surgically manageable.
  
  
  CONCLUSIONS
  EST for choledocholithiasis is safe and effective. Cholecystectomy after EST is recommended in patients with calculous GB, but is not necessary in patients with acalculous GB. Pneumobilia was associated with the recurrence of choledocholithiasis.
authors.affiliation: Division of Gastroenterology, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan. gastroenterol@hospital.fujieda.shizuoka.jp
authors.forename: Masanobu
authors.initials: M
authors.lastname: Kageoka
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Watanabe
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Maruyama
authors.forename: Ken
authors.initials: K
authors.lastname: Nagata
authors.forename: Akihiko
authors.initials: A
authors.lastname: Ohata
authors.forename: Yuji
authors.initials: Y
authors.lastname: Noda
authors.forename: Ichita
authors.initials: I
authors.lastname: Miwa
authors.forename: Kentarou
authors.initials: K
authors.lastname: Ikeya
mesh_terms: D000368:Aged; D002763:Cholecystectomy; D042883:Choledocholithiasis / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D016717:Sphincterotomy, Endoscopic