DIVERGENT EFFECTS OF ENDOSCOPIC SPHINCTEROTOMY ON THE LONG-TERM OUTCOME OF HEPATOLITHIASIS

Background: The long-term value of endoscopic sphincterotomy in patien ts with hepatolithiasis has not been established. Methods: Long-term c linical effects of endoscopic sphincterotomy on hepatolithiasis were d etermined in 57 patients. All patients had sphincterotomy to remove th eir common bile duct stones. Intrahepatic stones were removed complete ly in 21 patients, while the stones partly remained in 36 patients des pite combined use of surgery and/or percutaneous trans-hepatic choledo choscopy. Three patients of the latter group spontaneously passed all the remaining stones soon after the sphincterotomy. Results: Follow-up at 66 to 183 months (mean, 114 months) was available in 54 patients ( 94.7%). Late complications occurred in 10 patients with the remaining stones, including seven cases of cholangitis (two fatalities) and thre e of liver abscess (one fatality). In contrast, those with complete cl earance developed no complications. Conclusions: Endoscopic sphinctero tomy has divergent effects on the long-term outcome of patients with h epatolithiasis. Every effort should be made to remove the intrahepatic stones as completely as possible shortly after sphincterotomy if the patient is to be managed endoscopically and adverse effects are to be avoided.