Endoscopic treatment of common bile duct stones. Experience of 64 consecutive patients

Sixty-four consecutive patients who underwent endoscopic sphincterotomy (ES) for common bile duct stones were reviewed. In the early phase, duct clearance was confirmed in 39 patients (61%). In the majority (21 patients), the stone/stones passed spontaneously after ES. The most common cause of failure was inability to perform ES (12 patients). After ES, only two patients needed early surgery for obstruction. One more patient was operated on because the stone was too big for extraction or spontaneous passing.--Ten patients with probably retained stones after ES were followed for six months to three years. Bile duct obstruction recurred in three of them: two were treated successfully with extracorporeal shock wave lithotripsy and one underwent repeated ES and stone extraction. The complication rate was low. One female patient died of Legionella pneumonia, but the relationship between the death and the procedure remained uncertain. One female patient needed emergency surgery for massive bleeding: she recovered normally. Nasobiliary drain or any kind of stenting were not used and there was no case of cholangitis after ES. Altogether 12 patients needed surgery because of failure of the endoscopic treatment. There was no mortality or severe complications in these operations.