Endoscopic sphincterotomy in poor-risk patients

During the period February 1981--February 1986 101 poor-risk patients with common bile duct stones were treated with EST (endoscopic sphincterotomy). 51 of the patients had no previous gallbladder surgery. The first year 7 complications occurred among 11 patients, including 3 deaths. The following four years we had a total of 8 complications among 90 patients, including 1 death. The complications consisted of: Bleeding needing transfusion (n = 5), pancreatitis (n = 5), cholangitis (n = 2), perforation (n = 2), impaction of the Dormia basket (n = 1). Fourty-five patients were discharged without cholecystectomy. Two patients later underwent elective cholecystectomy. Four patients developed symptoms requiring cholecystectomy. The remaining 39 patients have not required any further treatment for their gallstone disease. This study demonstrates that EST in experienced hands is a safe and effective method even in extremely poor-risk patients and that EST might be used as the sole treatment of common bile duct stones in this type of patients without previous cholecystectomy. The few complications are mostly mild and can be managed conservatively.