[Clinical significance of endoscopic sphincterotomy compared with surgical common bile duct exploration and surgical...

Records of 940 patients with endoscopic sphincterotomy (ES) and 100 patients with choledochotomy for stone removal were compared. Those with ES were characterized by older mean age (65.9 vs. 60.6, p < 0.001), similar frequency of operative risks (36% vs. 45%), and a less complication rate (8.2% vs. 53%, p < 0.001) as compared with the surgery group. Complications of ES included cholangitis, pancreatitis, bleeding, and basket impaction. One patient each with cholangitis and pancreatitis died, thus a mortality rate of 0.2%. Complications of choledochotomy occurred in 53 patients with no death. Most of them were associated with anesthesia, laparotomy, wound and immobilization. The complications of ES should decrease due to recent development of lithotripsy instruments and endoscopic stenting to prevent cholangitis. Follow-up of 74 patients 15-21 years after surgical sphincterotomy revealed recurrent stones in 3.5%, which was lower than a recurrence rate of 10.3% in 290 patients 5-14 years after ES. However, that rate may be an underestimate, because the follow-up was obtained in only 79% of those with surgical sphincterotomy as compared with 99% of ES. Ninety percent of those with recurrence after ES underwent endoscopic treatments again, whereas 10% had surgery. Easy repetition at the time of recurrence is one of major advantages of the endoscopic treatment.