Early endoscopic sphincterotomy for retained bile duct stones after gallbladder surgery

Endoscopic sphincterotomy (ES) was performed in 36 patients (age range 33-88 years; median 63 years) with retained bile duct stones after cholecystectomy (32 patients) or cholecystostomy (4 patients). The median time interval between surgery and ES was 28 days (range 10-216 days). At the time of ES, 23 patients had a T-tube in situ. Clearance of the bile duct was achieved by T-tube irrigation in 15 patients, and by basket or balloon extraction in seven patients. Spontaneous clearance of the duct after ES occurred in 12 patients, while two patients required widening of the sphincterotomy to allow successful basket extraction. Complications occurred in four patients (11%). Two patients sustained significant haemorrhage from the ES site and subsequently died. One patient developed mild acute pancreatitis while another had persisting cholangitis before and after ES. Both of these patients recovered with conservative management. While ES performed soon after gallbladder surgery allows for early bile duct clearance, the small but significant risk of potentially lethal haemorrhage suggests that its use should be reserved for patients in whom other non-operative methods have failed or are inappropriate.