Endoscopic treatment of choledocholithiasis in the era of laparoscopic cholecystectomy: Prospective analysis of 386 patients

Background/Aims: Endoscopic papillotomy is a well-established procedure for treating choledocholithiasis. The aim of this study is to expose our exper ience with this method in a prospectively collected series of 386 patients and to analyze the safety and efficacy of the pre-cut procedure. Methodology: Between October 1995 and December 1999, 760 endoscopic retrogr ade cholangiopancreatographies were performed in 670 patients. Of these, 44 9 were done to treat 386 patients with choledo-cholithiasis. The pre-cut te chnique was performed after failure of multiple cannulation attempts. Results: Bile duct clearance was achieved in 344 (89.1%) cases, however the success rate would increase to 95.1%, if the cases, which endoscopic stone extraction was not feasible, were excluded. Pre-cut was performed in 31 (8 .03%) patients, and 11 of them presented some procedure-related complicatio n, while the complication rate of standard sphincterotomy was 3.9% (relativ e risk = 8.4; 95% confidence interval = 4.2-16.7). Overall complication rat e was 6.7% (26 out of 386) - pancreatitis = 13, bleeding = 9, acute cholecy stitis = 2, cholangitis = 1, guidewire-related choledochal perforation = 1. Thirty-day mortality was 1.55% (n = 6), but procedure-related mortality wa s 0.25% (n = 1). Conclusions: Endoscopic papillotomy is a safe and effective procedure for p atients with symptomatic choledocholithiasis. The pre-cut procedure increas es the complication rate of the endoscopic approach, and should be restrict ed to cases, in which an endoscopic intervention is mandatory.