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Choledocholithiasis in cirrhotic patients: is endoscopic sphincterotomy the safest choice?
V F Moreira1, R Arribas, A L Sanroman
1Gastroenterology Service, Hospital Ramón y Cajal, Madrid, Spain.
Insights
Endoscopic sphincterotomy for bile duct stones in cirrhotic patients has a high mortality rate (16.6%). However, considering only successful procedures (6.6%), it is a recommended initial treatment due to lower mortality than alternatives.
Area of Science:
- Gastroenterology
- Hepatology
- Surgical Endoscopy
Background:
- Choledocholithiasis (bile duct stones) poses significant risks in patients with liver cirrhosis.
- Management of choledocholithiasis in cirrhotic patients requires careful consideration of procedural risks and benefits.
Purpose of the Study:
- To evaluate the outcomes of endoscopic sphincterotomy in cirrhotic patients with choledocholithiasis.
- To compare the mortality rates of endoscopic sphincterotomy in this specific patient group with existing literature.
Main Methods:
- Retrospective analysis of 18 endoscopic sphincterotomies performed on 18 cirrhotic patients for choledocholithiasis.
- Calculation of overall and success-adjusted mortality rates.
Main Results:
- An overall mortality rate of 16.6% was observed in the study cohort.
- The mortality rate, when considering only successful procedures (83.3%), was 6.6%.
- Literature review suggests comparable cases have significantly higher operative mortality.
Conclusions:
- Endoscopic sphincterotomy is recommended as the initial management for choledocholithiasis in cirrhotic patients.
- Despite a higher mortality rate compared to the general population, it offers a better survival outcome than alternative treatments in this high-risk group.
Abstract:
Of the 18 endoscopic sphincterotomies performed on 18 cirrhotic patients for choledocholithiasis, a mortality rate of 16.6% was registered. However, this figure can be limited to 6.6% if we take only successful sphincterotomies (15/18, 83.3%) into account. After closely reviewing relevant literature, it would appear that operative mortality in comparable cases is much higher. We therefore recommend that endoscopic sphincterotomy, despite higher mortality rates when compared to the general population, should be the initial choice of management of choledocholithiasis in cirrhotic patients.