Abstract
The aim of this report is clarification of the usefulness of endoscopic sphincterotomy (EST) in therapy for choledocholithiasis. A total of 667 patients with choledocholithiasis treated by EST in our department and related hospitals from November 1975 to May 1992 were analyzed for success rate, incidence of complications, and long term prognosis. In the initial phase up to 1985, successful stone removal was accomplished in 430 out of 465 patients (92.5%) with complications in 32 patients (6.9%), including 9 patients of hemorrhage (1.9%), 8 pancreatitis (1.7%), 5 perforation (1.1%), 5 cholangitis (1.1%), 3 cholecystitis (0.6%), and 2 basket impaction (0.4%) . Of these, surgical management was required in 8 cases (1.7%) . Two patients died of cholangitis and one of hemorrhage (0.6%) . Since about 1986, transduodenal lithotripsy techniques, such as mechanical lithotripsy, electrohydraulic lithotripsy (EHL) and laser irradiation under peroral choledochoscopy (PCS) have been available. Such techniques have created great improvements in therapeutic capability. The incidence of complications, laparotomy and mortality have decreased significantly to 3.5%, 0.5% and 0%, respectively, compared to the initial phase. In long term follow-up, 226 patients were analyzed. Among them, 51 patients had been cholecystectomized before EST and 46 after, and 129 had gallbladder with stone (65 patients) or without stone (64) . Common bile duct stones recurred in 13 patients (5.8%) and cholecystitis occured in 6 patients (4.7%) with gallbladder stones. From our clinical experiences, we concluded as follows: (1) EST for choledocholithiasis is becoming a safer and more reliable lithotomy technique due to improvement of both instruments and skill. (2) Stone recurrence and incidence of cholecystitis in long term follow-up are at acceptable rates.
