The role of endoscopic papillotomy in ascending cholangitis

The role of endoscopic papillotomy in calculous cholangitis is unclear. A retrospective review of 41 patients admitted to hospital with calculous cholangitis was carried out. There were 30 women and 11 men and their ages ranged between 49 and 98 years (mean age 77). All patients presented with abdominal pain, tenderness, chills, and fever. Clinical jaundice was present in 95 per cent of the patients. Initial endoscopic papillotomy was successful in 17 of the 41 patients. In 24 patients cholangitis persisted or recurred and further therapy was carried out. Surgery was successful in controlling sepsis in ten of the 24 patients. Repeat endoscopic papillotomy was successful in four of 13 patients. Surgery was successful in one of nine patients who had failed repeat endoscopic papillotomy. Nasobiliary drainage and percutaneous transhepatic drainage of the common bile duct after failed repeat endoscopic papillotomy was successful in only two of nine patients. Six patients died after failed repeat endoscopic papillotomy. We conclude that initial endoscopic papillotomy should be attempted in patients with calculous cholangitis. Surgical exploration of the common bile duct should then be carried out if initial endoscopic papillotomy fails to control cholangitis.