PREDICTION OF RECURRENT CHOLEDOCHOLITHIASIS BY QUANTITATIVE CHOLESCINTIGRAPHY IN PATIENTS AFTER ENDOSCOPIC SPHINCTEROTOMY

Background-Endoscopic sphincterotomy (EST) is widely used for the remo val of stones from the bile duct, but stones recur in about one fifth of patients. Aims-To investigate hepatic clearance by quantitative cho lescintigraphy (QC) in patients after EST and to discern the relations hip between biliary emptying and stone recurrence. Methods-One hundred and forty nine patients who had EST and clearance of the bile duct fo r choledocholithiasis were selected. All patients were confirmed to ha ve complete EST by sphincter of Oddi manometry and underwent QC soon a fter normalisation of liver function. Regular clinical follow up was p erformed for each patient. Results-During a mean 36 month follow up, 2 2 (14.8%) patients developed recurrent stones in the bile duct. Irresp ective of the status of the gall bladder, patients with recurrent ston es had a slower hepatic clearance of radioisotope during QC compared w ith patients without stone recurrence, but only the differences in cho lecystectomised patients had statistical significance. After carrying out multivariate analysis, one parameter of QC, percentage clearance o f maximal count at 45 minutes, was found to be the only significant fa ctor for stone recurrence. All recurrent stones in the common bile duc t were successfully removed at endoscopy. Conclusion-Slower hepatic cl earance as shown by QC is an important factor responsible for stone re currence after sphincter ablation.