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Late Complications After Endoscopic Sphincterotomy.

Melissa Oliveira-Cunha1, Ashley R Dennison, Giuseppe Garcea

  • 1Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, NHS Trust, Leicester, UK.

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
|December 19, 2015
PubMed
Summary
This summary is machine-generated.

Endoscopic sphincterotomy (ES) effectively treats bile duct stones. While concerns exist about long-term risks like cholangiocarcinoma, current evidence suggests ES is safe, though caution is advised for the very young.

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Area of Science:

  • Gastroenterology
  • Hepatology
  • Surgical Oncology

Background:

  • Endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy (ES) is a primary treatment for choledocholithiasis.
  • Increasing use of ES in younger patients necessitates evaluating long-term anatomical and oncological risks.
  • Concerns focus on potential late complications, including biliary tract malignancy.

Purpose of the Study:

  • To review the relationship between ES for benign conditions and subsequent long-term complications.
  • To evaluate the risk of biliary tract malignancy, primary duct stones, and recurrent cholangitis after ES.
  • To assess the safety and efficacy of ES for common bile duct stones.

Main Methods:

  • A systematic review of published articles from 1970 to 2013 was conducted.
  • The review evaluated studies examining late complications following ES for benign diseases.
  • Data on biliary tract malignancy, primary duct stones, and cholangitis were analyzed.

Main Results:

  • ES is currently considered a safe and effective treatment for common bile duct stones.
  • The long-term risk of developing cholangiocarcinoma after ES is not definitively proven, with some studies having inadequate follow-up.
  • An increased incidence of cholangiocarcinomas post-sphincterotomy is observed, but causality is not established.

Conclusions:

  • While ES is effective, potential long-term risks warrant consideration, especially in younger populations.
  • The risk of cholangiocarcinoma following ES, if present, appears small in Western populations.
  • Longer follow-up studies are needed; avoiding ES in the very young may be prudent until more data is available.