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Choledocholithiasis. Endoscopic sphincterotomy or common bile duct exploration.
S C Stain1, H Cohen, M Tsuishoysha
1Department of Surgery, Los Angeles County-University of Southern California Medical Center.
Annals of Surgery
|June 1, 1991
Summary
Preoperative endoscopic sphincterotomy and surgery (ES&S) was compared to surgery alone (SA) for gallstones and bile duct stones. Surgery alone (SA) was more effective for clearing bile duct stones than ES&S.
Area of Science:
- Gastroenterology
- Surgical Oncology
Background:
- Cholelithiasis and choledocholithiasis often require surgical intervention.
- Preoperative interventions aim to clear the common bile duct (CBD) before definitive surgery.
Purpose of the Study:
- To compare the efficacy and outcomes of preoperative endoscopic sphincterotomy and surgery (ES&S) versus surgery alone (SA) for patients with gallstones and CBD stones.
Main Methods:
- A prospective randomized trial involving 52 patients undergoing elective surgery.
- Patients were randomized to either ES&S or SA groups.
- Stone clearance, morbidity, and costs were assessed.
Main Results:
- Post-ES&S, 65% of patients were stone-free; post-SA, 88% were stone-free (p < 0.05).
- Major hemorrhage occurred in one patient in each group; no deaths.
- Individual patient costs were similar, but societal costs for ES&S were higher due to screening.
Conclusions:
- Preoperative ES does not support clearance of CBD stones based on efficacy, morbidity, or cost.
- Surgery alone demonstrates superior efficacy in clearing CBD stones in this patient cohort.