ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY AND ENDOSCOPIC SPHINCTEROTOMY FOR BILIARY LITHIASIS - A PROSPECTIVE EVALUATION BY SURGEONS

Between January 1982 and 1987, 772 consecutive endoscopic retrograde c holangiopancreatographic examinations (ERCP) were performed in 673 con secutive patients suspected of having biliary tract lithiasis (mean ag e: 62.1 +/- 18.2 years). Two hundred and thirty-two were emergency pro cedures (30 %). Endoscopic sphincterotomy was performed for common bil e duct stones (CBDS) in 257 cases (38.0 %), of whom 143 (55.6 %) had u ndergone previous cholecystectomy. In 17.2 % of cases, ERCP was either a complete (7.8 %) or partial (9.4 %) failure. In 124 patients for wh om microlithiasis was not identified by sonography and who underwent o peration, sensitivity and specificity of ERCP was 70 % and 87 %, respe ctively. Of 266 patients in whom ES was attempted, 96.6 % were achieve d and the common bile duct was cleared of stones in 72 % of cases. Nin eteen percent of patients required two or more attempts at extraction. After ERCP without ES, mortality and morbidity rates were 0.96 and 3. 6 % respectively. After ES, complications followed in 12.1 % of patien ts and 3.9 % died. Mortality and morbidity directly related to ES were 3.1 % and 11.3 % respectively. The most common complications after ER CP were acute cholangitis and pancreatitis, whereas after ES, acute ch olangitis was the most common complication, followed by hemorrhage and duodenocholechocal perforations. These complications occured independ ently of age and previous cholecystectomy but was closely related to s tone clearance (P < 0.05). Seventy-one patients (10.5 %) required oper ation. Twenty-nine patients underwent emergency surgery for complicati ons with a mortality rate of 17 %. Forty-two patients underwent electi ve surgery for retained CBDS after ES without any mortality. ES is eff icient in the treatment of CBDS, but the morbidity and mortality rates are often underestimated. Prospective, cooperative studies are needed to define the respective indications of endoscopic and surgical treat ments of CBDS.