FACTORS PREDICTIVE OF EARLY COMPLICATIONS OF ENDOSCOPIC TREATMENT OF BILE-DUCT CALCULI

Background/Aims: Factors associated with an increased early complicati on rate of the endoscopic sphincterotomy procedure have been identifie d. Precut or needle knife papillotomy has been shown to improve the su ccess rate of endoscopic retrograde cholangiography and endoscopic sph incterotomy, but has often been reported to be hazardous. In order to identify patients with bile duct stones at risk for a complicated cour se in connection with endoscopic clearance of the calculi, factors pre dictive of early complications were sought. Methodology: 417 consecuti ve patients with bile duct calculi at endoscopic retrograde cholangiog raphy were considered for endoscopic treatment in our department from 1981 to 1992. Endoscopic sphincterotomy was performed in 246 patients with intact gallbladders and in 147 with prior cholecystectomy, 55 of whom had retained calculi. Results: There was a 9.4% overall and 7.1% major early complication rate of the EST procedure and a 30-day mortal ity of 0.5% (2 patients, non-procedure related). In 22% (6/27) of the patients with major complications, surgery was required or preferred t o additional endoscopic measures. Complete stone removal failed in 35/ 393 patients (8.9%). The immediate and early complication rate of stan dard sphincterotomy was not found to be increased in patients with pri or or present biliopancreatic complications, failed bile duct clearanc e at first attempt, or juxtapapillary diverticula. It was the same aft er standard sphincterotomy as after precut papillotomy followed by imm ediate or delayed sphincterotomy. No increased morbidity was found aft er failed therapy was compared to failed diagnostic precut papillotomy . There was neither a greater need for, nor an increased complication rate following, precut papillotomy in patients with, as compared to th ose without, juxtapapillary diverticula. Endoscopic experience did not influence the complication rate. There were no significant difference s regarding outcome or risk factors associated morbidity between patie nts with and without intact gallbladder. Conclusions: These findings c onfirm that endoscopic treatment is safe and that precut papillotomy c an be performed without increased morbidity. Furthermore, none of the commonly identified factors associated with increased morbidity were f ound to be risk factors in this study.