Recurrence of biliary symptoms after endoscopic sphincterotomy for choledocholithiasis in patients with gall bladder stones

Background: There are a few reports regarding the long-term results of endo scopic sphincterotomy (EST). However, little data is available on the recur rence of biliary symptoms after EST for choledocholithiasis, in patients wi th gall bladder stones. Methods: All patients had gall bladder and common bile duct stones (n = 60; age 32-84 years, median age 55 years), and had received an EST. One group of these patients had a laparoscopic or open cholecystecomy (n = 39; group A), while the other group did not (n = 21; group B). The follow-up period r anged from 5 to 54 months (average 22 months). Results: Complications included the recurrence of common bile duct stones, recurrent acute cholecystitis, postoperative bile leakage and papillary ste nosis. Nine patients (15%) had a recurrence of biliary symptoms. Two signif icant prognostic factors for the recurrence of biliary symptoms were identi fied by multivariate analysis; namely an intact gall bladder and a dilated common bile duct. The recurrence rate of biliary symptoms in group B was 20 .4%, while in group A it was 10.3% (P < 0.01). Patients with a larger than average common bile duct diameter (mean diameter 14 mm) were more prone to the recurrence of symptoms than those with a smaller common bile duct diame ter (mean diameter 10 mm, P < 0.016). The hospital stay period was 8.9 +/- 3.1 days in group A and 2.8 +/- 1.9 days in group B (P < 0.01). Conclusions: Biliary symptom recurrence occurred in a considerable proporti on of patients after EST for the treatment of choledocholithiasis, in patie nts with gall bladder stones. The prognostic factors associated with the re currence of biliary symptoms were an intact gall bladder and a dilated comm on bile duct diameter. Regardless of their short stay in hospital, non-chol ecystectomy patients had a higher rate of recurrent biliary symptoms than c holecystectomy patients. (C) 2000 Blackwell Science Asia Pty Ltd.