Endoscopic Treatment of Bile Duct Calculi in Patients with Gallbladder in Situ

Kang, Eun Hee; Na, Young Sook; Lee, Sung Hong; Choi, Tae Young; Shin, Won Chang; Lee, Jin Ho; Choi, Won Choong; Kim, Kwan Yop

Abstract

BACKGROUND/AIMS: Endoscopic sphincterotomy (EST) is a safe and effective method of managing CBD calculi. But whether EST of CBD calculi in patients with gallbladder in situ should be followed by routine post-EST cholecystectomy, is still a subject of controversy. The aims of this study was to identify the recurrence rate and predictive factors of biliary symptoms after EST of CBD calculi in patients with gallbladder in situ.
METHODS
90 patients of CBD calculi with intact gallbladder treated with endoscopic sphincterotomy from 1992 to 1998 were reviewed. Follow up on the patients consisted of phone calls or personal interviews and the length of the follow up ranged from 6 to 77 months.
RESULTS
Cholecystectomy was required in 12 patients (13.3%) due to recurrent biliary symptoms and the remaining 78 patients (86.6%) were symptom free. Of the recurrence, 67.7% occurred within 12 months after EST and only one occurred after 5 years of follow-up. The risk of recurrence was higher in those patients with periampullary diverticulum in ERCP.
CONCLUSIONS
The low recurrence rate of 13.3% after EST of CBD stones in patients with gallbladder in situ hardly justifies routine post-EST cholecystectomy and rather suggests selective post-EST cholecystectomy especially in high operative risk patients.