ENDOSCOPIC SPHINCTEROTOMY FOR BILE-DUCT CALCULI - FACTORS INFLUENCINGTHE SUCCESS RATE

Background/Aims: Endoscopic sphincterotomy is an. established treatmen t of retained or recurrent common bile duct calculi after cholecystect omy and in the majority of patients with an, intact gallbladder. In or der to identify patients ultimately requiring additional endoscopic pr ocedures or surgery, factors predictive of decreased endoscopic bile d uct clearance were sought. Material and Methods: Between. 1981 and 199 2 endoscopic sphincterotomy was performed in 393 consecutive patients with either intact gallbladders (n=246), recurrent (n=92) or retained (n=55) calculi. Results: There was a 9.4% overall early complication r ate for the procedure and a 30-day mortality rate of 0.5% (two patient s, non-procedure related). Complete removal of all bile duct calculi f ailed in 35/393 patients (8.9%). In patients with intact gallbladder t he clearance rate at first attempt was higher (p=0.002; Chi-square tes t) in the presence of solitary as compared to multiple stones. The sam e was found in. patients with recurrent stones as well (p<0.001). In n on-cholecystectomized patients with single or multiple stones smaller than. 10 mm, the clearance rate was higher at first (p=0.02) as well a s at final (p<0.002) attempt as compared to patients with larger stone s. Single small (<10 mm) compared to single large stones in patients w ith intact gallbladder had a higher clearance rate at final (p=0.002) but not at first (p=0.18) attempt. Patients with intact gallbladder an d pancreatitis had higher clearance rate at first attempt compared to patients with jaundice (p=0.001) or patients without concomitant pancr eatobiliary disease (p=0.002). Clearance rate was the same in patients with and without endoscopic sphincterotomy complications, except for patients with basket impaction, in, whom the clearance rate was decrea sed (p=0.02). Conclusions: Thus, in patients with intact gallbladder s urgery should be considered after failed complete bile duct clearance at first attempt.