Endoscopic treatment of choledocholithiasis in the era of laparoscopic cholecystectomy: prospective analysis of 386 patients
Pereira-Lima, J.C.; Rynkowski, C.B.; Rhoden, E.L.
Hepato-Gastroenterology 48(41): 1271-1274
2001
ISSN/ISBN: 0172-6390 PMID: 11677944 Document Number: 538482
Background/Aims: Endoscopic papillotomy is a well-established procedure for treating choledocholithiasis. The aim of this study is to expose our experience with this method in a prospectively collected series of 386 patients and to analyze the safety and efficacy of the pre-cut procedure. Methodology: Between October 1995 and December 1999, 760 endoscopic retrograde cholangiopancreatographies were performed in 670 patients. Of these, 449 were done to treat 386 patients with choledocholithiasis. The pre-cut technique was performed after failure of multiple cannulation attempts. Results: Bile duct clearance was achieved in 344 (89.1%) cases, however the success rate would increase to 95.1%, if the cases, which endoscopic stone extraction was not feasible, were excluded. Pre-cut was performed in 31 (8.03%) patients, and 11 of them presented some procedure-related complication, while the complication rate of standard sphincterotomy was 3.9% (relative risk=8.4; 95%, confidence interval= 4.2-16.7). Overall complication rate was 6.7% (26 out of 386) - pancreatitis=13, bleeding=9, acute cholecystitis=2, cholangitis=1, guide-wire-related choledochal perforation=1. Thirty-day mortality was 1.55% (n=6), but procedure-related mortality was 0.25% (n=1). Conclusions: Endoscopic papillotomy is a safe and effective procedure for patients with symptomatic choledocholithiasis. The pre-cut procedure increases the complication rate of the endoscopic approach, and should be restricted to cases, in which an endoscopic intervention is mandatory.