LONG-TERM FOLLOW-UP AFTER ENDOSCOPIC TREATMENT OF BILE-DUCT CALCULI IN CHOLECYSTECTOMIZED PATIENTS

Endoscopic sphincterotomy (EST) is an established method for treatment of retained or recurrent common bile duct (CBD) catculi after cholecy stectomy. Present experience shows that few patients hare recurrent bi liary tract complications, but follow-up periods are most often short. EST was performed in 147 patients with bile duct calculi and remote c holecystectomy in our department from 1951 to 1992. In 8 of 147 patien ts (5.4%) complete removal of calculi failed. A total of 135 patients with a median age of 71 years (range 24-96 gears) were eligible for a follow-up of 23 to 153 months (median 86 months). Thirty-seven patient s have died without recurrent symptoms (a recurrent stone was revealed at postmortem examination in one patient), and four patients (two wit h calculi and two with cholangiocarcinoma) died with recurrent symptom s from the biliary tract. Ninety-four patients are alive; and with the exception of two who have had cholangitis without or with post-EST st enosis, respectively, they are all symptom-free. Jaundice, cholangitis , and biliary pancreatitis prior to EST were the only factors that sig nificantly (p = 0.006, Fisher's exact test) predicted late biliary com plications after EST in patients with recurrent calculi. These finding s confirm that endoscopic treatment of CBD calculi in cholecystectomiz ed patients has a low long-term rate (5 of 135; 3.7%) of recurrent non malignant bile duct disease (three patients with CBD calculi and two w ith cholangitis).