Endoscopic retreatment of recurrent choledocholithiasis after sphincterotomy
| Autor: | N Abe, Toshiyuki Mori, T Masaki, Y Atomi, Masanori Sugiyama, Yutaka Suzuki |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty Stone clearance digestive system Pancreas and Biliary Biliary disease Sphincterotomy Endoscopic Cholelithiasis Recurrence Risk Factors Humans Medicine Risk factor Aged Retrospective Studies Aged 80 and over Cholangiopancreatography Endoscopic Retrograde Endoscopic retrograde cholangiopancreatography medicine.diagnostic_test business.industry Bile duct General surgery Gastroenterology Retrospective cohort study Middle Aged medicine.disease digestive system diseases Endoscopy Surgery Choledocholithiasis Treatment Outcome surgical procedures operative medicine.anatomical_structure Commentary Female business Complication Follow-Up Studies |
| Zdroj: | Gut. 53:1856-1859 |
| ISSN: | 0017-5749 |
| DOI: | 10.1136/gut.2004.041020 |
| Popis: | Background: Endoscopic sphincterotomy (ES) carries a substantial risk of recurrent choledocholithiasis but retreatment with endoscopic retrograde cholangiopancreatography (ERCP) is safe and feasible. However, long term results of repeat ERCP and risk factors for late complications are largely unknown. Aims: To investigate the long term outcome of repeat ERCP for recurrent bile duct stones after ES and to identify risk factors predicting late choledochal complications. Methods: Eighty four patients underwent repeat ERCP, combined with ES in 69, for post-ES recurrent choledocholithiasis. Long term outcomes of repeat ERCP were retrospectively investigated and factors predicting late complications were assessed by multivariate analysis. Results: Complete stone clearance was achieved in all patients. Forty nine patients had no visible evidence of prior sphincterotomy. Two patients experienced early complications. During a follow up period of 2.2–26.0 years (median 10.9 years), 31 patients (37%) developed late complications, including stone recurrence (n = 26), acute acalculous cholangitis(n = 4), and acute cholecystitis (n = 1). There were neither biliary malignancies nor deaths attributable to biliary disease. Multivariate analysis identified three independent risk factors for choledochal complications: interval between initial ES and repeat ERCP ⩽5 years, bile duct diameter ⩾15 mm, and periampullary diverticulum. Choledochal complications were successfully treated with repeat ERCP in 29 patients. Conclusions: Choledochal complications after repeat ERCP are relatively frequent but are endoscopically manageable. Careful follow up is necessary, particularly for patients with a dilated bile duct, periampullary diverticulum, or early recurrence. Repeat ERCP is a reasonable treatment even for recurrent choledocholithiasis after ES. |
| Databáze: | OpenAIRE |
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