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[Endoscopic papillotomy in preserved gallbladder].

H Bühler, P Deyhle, R Münch

    Schweizerische Medizinische Wochenschrift
    |September 3, 1983
    PubMed
    Summary
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    Endoscopic papillotomy is a safe and effective treatment for common bile duct stones in high-risk elderly patients with a gallbladder. Gallbladder complications are rare and often linked to early follow-up or cystic duct occlusion.

    Area of Science:

    • Gastroenterology
    • Endoscopic procedures
    • Biliary tract disease

    Context:

    • Common bile duct stones pose significant risks, especially in elderly patients.
    • High-risk patients often have comorbidities making traditional surgery challenging.
    • Preserved gallbladder function in these patients requires specific management considerations.

    Purpose:

    • To evaluate the safety and efficacy of endoscopic papillotomy for common bile duct stones in high-risk elderly patients with an intact gallbladder.
    • To assess the incidence and nature of gallbladder-related complications following endoscopic papillotomy.
    • To determine the long-term outcomes and symptom-free survival in patients managed conservatively without cholecystectomy.

    Summary:

    • Endoscopic papillotomy was performed in 60 high-risk patients (mean age 76) with common bile duct stones and preserved gallbladders.

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  • Successful bile duct clearance was achieved in 93% (56/60) of patients.
  • In patients without cholecystectomy (n=47), 74% remained symptom-free, with 11% experiencing nonspecific dyspeptic pain and 4% biliary colic. Gallbladder complications occurred in 11% (5/47), primarily early or with cystic duct occlusion.

    • Impact:

    • Endoscopic papillotomy is a justified treatment for common bile duct stones in high-risk patients with preserved gallbladders.
    • Gallbladder complications are infrequent but necessitate vigilance, particularly in early follow-up or cases with cystic duct occlusion.
    • Early cholecystectomy is recommended for acute cholecystitis to prevent empyema.