title: Management of late biliary complications in patients with gallbladder stones in situ after endoscopic papillary balloon dilation.
abstract: OBJECTIVE
  Patients with untreated gallbladder stones in situ are at high risk for late biliary complications after endoscopic papillary balloon dilation (EPBD) and bile duct stone extraction. Few data exist on the short-term and long-term results in these patients after the recurrence of bile duct stones and acute cholecystitis. The aim of this study was to evaluate the outcome of late biliary complications in patients with gallbladder stones in situ after EPBD.
  
  
  METHODS
  Fifty-six patients who developed late biliary complications, including bile duct stone recurrence (n=43) and acute cholecystitis (n=13), were managed at our institutions. We investigated the short-term and long-term outcomes after the management of late biliary complications.
  
  
  RESULTS
  Complete removal of recurrent bile duct stones was achieved in 38 of 43 patients (88%) by repeated EPBD alone. Pancreatitis after repeated EPBD occurred in two patients (5%). After successful bile duct stone extraction by EPBD, none of the 16 patients who underwent cholecystectomy developed late biliary complications (mean follow-up period of 5.2 years), wheras re-recurrent bile duct stones occurred in three of the 21 patients (14%) with gallbladder stones left in situ (mean follow-up period of 4.4 years)(P=0.1148). Re-recurrent bile duct stones were successfully treated endoscopically. One of the eight patients who did not undergo cholecystectomy for acute cholecystitis had a recurrence of cholecystitis, which was managed conservatively.
  
  
  CONCLUSIONS
  The long-term outcomes of late biliary complications are favorable when patients with concomitant gallbladder stones undergo cholecystectomy. Re-recurrent bile duct stones are considerable when gallbladder stones are left in situ, but should be treated endoscopically.
authors.affiliation: Department of Gastroenterology, University of Tokyo, Tokyo, Japan. tsujinot-int@h.u-tokyo.ac.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsujino
authors.forename: Takao
authors.initials: T
authors.lastname: Kawabe
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.forename: Yoko
authors.initials: Y
authors.lastname: Yashima
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yagioka
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kogure
authors.forename: Takashi
authors.initials: T
authors.lastname: Sasaki
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Arizumi
authors.forename: Osamu
authors.initials: O
authors.lastname: Togawa
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Ito
authors.forename: Saburo
authors.initials: S
authors.lastname: Matsubara
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nakai
authors.forename: Naoki
authors.initials: N
authors.lastname: Sasashira
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirano
authors.forename: Minoru
authors.initials: M
authors.lastname: Tada
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D002763:Cholecystectomy; D041881:Cholecystitis, Acute / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012008:Recurrence; D016717:Sphincterotomy, Endoscopic; D016896:Treatment Outcome