LONG-TERM CONSEQUENCE OF ENDOSCOPIC SPHINCTEROTOMY FOR BILE-DUCT STONES

Background: There are many reports of early- and intermediate-term res ults of endoscopic sphincterotomy. However, few data are available on long-term clinical outcome of endoscopic sphincterotomy for removal of common bile duct stones. Methods: Of 419 patients who underwent endos copic sphincterotomy, followup data were obtained in 410 patients (98% ). The period ranged from 1 month to 20 years (average 122 months). Re sults: Late complications included recurrence of stones (12.3%), acute cholangitis, acute cholecystitis (22% of 32 patients with gallstones, 0% of 88 patients without gallstones), new gallstone formation (6 pat ients), liver abscess (5 patients), and biliary carcinoma (8 patients) . All of the recurrent stones were bilirubinate irrespective of the ty pe of stone at sphincterotomy. Cholangitis and liver abscess occurred in 31% and 11%, respectively, of patients with residual intrahepatic s tones but not in patients with complete intrahepatic stone clearance. Conclusions: Late complications occur in a considerable proportion of patients after endoscopic sphincterotomy for the treatment of common b ile duct stones, including stone recurrence, acute cholecystitis (whic h occurs only in patients with gallstones), liver abscess in patients with residual intrahepatic stones, and biliary carcinoma. The fact tha t the recurrent stones are invariably of the bilirubinate type, irresp ective of the type of stones at initial treatment, suggests that bacte rial infestation due to ablation of the sphincter mechanism may have a causative role.