Endoscopic sphincterotomy in acute cholangitis due to choledocholithiasis

Area of Science:

• Gastroenterology
• Hepatobiliary Surgery
• Endoscopic Procedures

Background:

• Acute cholangitis is a serious biliary tract infection often caused by choledocholithiasis (common bile duct stones).
• Prompt treatment is crucial to prevent sepsis and improve patient outcomes.
• Endoscopic sphincterotomy is a minimally invasive technique for managing biliary obstructions.

Purpose of the Study:

• To evaluate the efficacy and safety of endoscopic sphincterotomy for treating acute cholangitis secondary to choledocholithiasis.
• To assess the long-term outcomes and symptom-free status of patients treated with this method.

Main Methods:

• A consecutive series of 30 patients diagnosed with acute cholangitis due to choledocholithiasis were treated with endoscopic sphincterotomy.
• Treatment success was determined by normalization of liver function tests (serum alkaline phosphatase, bilirubin) and body temperature.
• Patients were followed up for a mean of 22 months to assess long-term symptom resolution and complications.

Main Results:

• Endoscopic sphincterotomy resulted in satisfactory treatment for 83% of patients, evidenced by normalized liver enzymes and temperature.
• The procedure was unsuccessful in 4 patients due to large stone size, necessitating surgical intervention.
• No short-term complications were observed in patients who underwent endoscopic sphincterotomy.
• At a mean follow-up of 22 months, 84% of patients remained completely symptom-free.

Conclusions:

• Endoscopic sphincterotomy is a simple, rapid, and effective treatment for acute cholangitis caused by choledocholithiasis.
• Instrumental stone extraction via endoscopic sphincterotomy should be considered the primary treatment for most affected patients.
• Relieving biliary obstruction and normalizing intrabiliary pressure are essential for favorable outcomes in acute cholangitis management.