Long-term outcomes after endoscopic sphincterotomy versus endoscopic papillary balloon dilation for bile duct stones.
OBJECTIVE
Endoscopic sphincterotomy (ES) is a well-established standard method for treating common bile duct stones. However, biliary sphincter function is impaired after the treatment, and this may influence the long-term outcomes. In this study, we aimed to compare the long-term outcomes after ES with those after endoscopic papillary balloon dilation (EPBD) because the latter procedure is expected to preserve biliary sphincter function better than ES.


METHODS
A prospective follow-up of the original cohort in a previously randomized, controlled trial to compare the early outcomes after ES and EPBD.


METHODS
Eleven centers, including 6 clinical practices and 5 academic institutions.


METHODS
A total of 282 patients with common bile duct stones were randomly selected to undergo ES (n = 144) or EPBD (n = 138) in the previous study.


METHODS
ES or EPBD.


METHODS
Complications after ES or EPBD occurring during long-term follow-up.


RESULTS
The patients were followed up annually after the treatment. The median duration of the follow-up was 6.7 years. Morbidity was observed in 36 (25.0%) and 14 (10.1%) of the patients who underwent ES and EPBD, respectively (P = .0016). Kaplan-Meier analysis revealed a significantly higher incidence of biliary complications in the ES group than in the EPBD group (P = .0011). Multivariate analysis showed that ES, periampullary diverticulum, and in situ gallbladder stones were independent risk factors for stone recurrence.


CONCLUSIONS
During long-term follow-up, patients who underwent ES had significantly more biliary complications than those who underwent EPBD. The biliary sphincter dysfunction after ES results in additional late complications.
Yasuda
Ichiro
I
First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
Fujita
Naotaka
N
Maguchi
Hiroyuki
H
Hasebe
Osamu
O
Igarashi
Yoshinori
Y
Murakami
Akihiko
A
Mukai
Hidekazu
H
Fujii
Tsuneshi
T
Yamao
Kenji
K
Maeshiro
Kensei
K
Tada
Tomoko
T
Tsujino
Takeshi
T
Komatsu
Yutaka
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000628:therapy*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D016717:Sphincterotomy, Endoscopic