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Endoscopic sphincterotomy for bile duct calculi: factors influencing the success rate. Hepato-Gastroenterol 1996; 43: 127-133.

Hammarström, L-E; Stridbeck, Hans LU and Ihse, Ingemar LU (1996) In Hepato-Gastroenterology 43(7). p.127-133
Abstract
BACKGROUND/AIMS: Endoscopic sphincterotomy is an established treatment of retained or recurrent common bile duct calculi after cholecystectomy and in the majority of patients with an intact gallbladder. In order to identify patients ultimately requiring additional endoscopic procedures or surgery, factors predictive of decreased endoscopic bile duct clearance were sought. MATERIAL AND METHODS: Between 1981 and 1992 endoscopic sphincterotomy was performed in 393 consecutive patients with either intact gallbladders (n = 246), recurrent (n = 92) or retained (n = 55) calculi. RESULTS: There was a 9.4% overall early complication rate for the procedure and a 30-day mortality rate of 0.5% (two patients, non-procedure related). Complete removal of... (More)
BACKGROUND/AIMS: Endoscopic sphincterotomy is an established treatment of retained or recurrent common bile duct calculi after cholecystectomy and in the majority of patients with an intact gallbladder. In order to identify patients ultimately requiring additional endoscopic procedures or surgery, factors predictive of decreased endoscopic bile duct clearance were sought. MATERIAL AND METHODS: Between 1981 and 1992 endoscopic sphincterotomy was performed in 393 consecutive patients with either intact gallbladders (n = 246), recurrent (n = 92) or retained (n = 55) calculi. RESULTS: There was a 9.4% overall early complication rate for the procedure and a 30-day mortality rate of 0.5% (two patients, non-procedure related). Complete removal of all bile duct calculi failed in 35/393 patients (8.9%). In patients with intact gallbladder the clearance rate at first attempt was higher (p = 0.002; Chi-square test) in the presence of solitary as compared to multiple stones. The same was found in patients with recurrent stones as well (p < 0.001). In non-cholecystectomized patients with single or multiple stones smaller than 10 mm, the clearance rate was higher at first (p = 0.02) as well as at final (p < 0.002) attempt as compared to patients with larger stones. Single small ( < 10 mm) compared to single large stones in patients with intact gallbladder had a higher clearance rate at final (p = 0.002) but not at first (p = 0.18) attempt. Patients with intact gallbladder and pancreatitis had higher clearance rate at first attempt compared to patients with jaundice (p = 0.001) or patients without concomitant pancreatobiliary disease (p = 0.002). Clearance rate was the same in patients with and without endoscopic sphincterotomy complications, except for patients with basket impaction, in whom the clearance rate was decreased (p = 0.02). CONCLUSIONS: Thus, in patients with intact gallbladder surgery should be considered after failed complete bile duct clearance at first attempt. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Hepato-Gastroenterology
volume
43
issue
7
pages
127 - 133
publisher
Georg Thieme Verlag
external identifiers
  • scopus:0029924131
ISSN
0172-6390
language
English
LU publication?
yes
id
fe526a8b-90b7-49e8-8e6f-6d8f2d3bdf34 (old id 30888)
date added to LUP
2007-06-12 11:35:21
date last changed
2017-01-15 04:17:13
@article{fe526a8b-90b7-49e8-8e6f-6d8f2d3bdf34,
  abstract     = {BACKGROUND/AIMS: Endoscopic sphincterotomy is an established treatment of retained or recurrent common bile duct calculi after cholecystectomy and in the majority of patients with an intact gallbladder. In order to identify patients ultimately requiring additional endoscopic procedures or surgery, factors predictive of decreased endoscopic bile duct clearance were sought. MATERIAL AND METHODS: Between 1981 and 1992 endoscopic sphincterotomy was performed in 393 consecutive patients with either intact gallbladders (n = 246), recurrent (n = 92) or retained (n = 55) calculi. RESULTS: There was a 9.4% overall early complication rate for the procedure and a 30-day mortality rate of 0.5% (two patients, non-procedure related). Complete removal of all bile duct calculi failed in 35/393 patients (8.9%). In patients with intact gallbladder the clearance rate at first attempt was higher (p = 0.002; Chi-square test) in the presence of solitary as compared to multiple stones. The same was found in patients with recurrent stones as well (p &lt; 0.001). In non-cholecystectomized patients with single or multiple stones smaller than 10 mm, the clearance rate was higher at first (p = 0.02) as well as at final (p &lt; 0.002) attempt as compared to patients with larger stones. Single small ( &lt; 10 mm) compared to single large stones in patients with intact gallbladder had a higher clearance rate at final (p = 0.002) but not at first (p = 0.18) attempt. Patients with intact gallbladder and pancreatitis had higher clearance rate at first attempt compared to patients with jaundice (p = 0.001) or patients without concomitant pancreatobiliary disease (p = 0.002). Clearance rate was the same in patients with and without endoscopic sphincterotomy complications, except for patients with basket impaction, in whom the clearance rate was decreased (p = 0.02). CONCLUSIONS: Thus, in patients with intact gallbladder surgery should be considered after failed complete bile duct clearance at first attempt.},
  author       = {Hammarström, L-E and Stridbeck, Hans and Ihse, Ingemar},
  issn         = {0172-6390},
  language     = {eng},
  number       = {7},
  pages        = {127--133},
  publisher    = {Georg Thieme Verlag},
  series       = {Hepato-Gastroenterology},
  title        = {Endoscopic sphincterotomy for bile duct calculi: factors influencing the success rate. Hepato-Gastroenterol 1996; 43: 127-133.},
  volume       = {43},
  year         = {1996},
}