[Choledocholithiasis following cholecystectomy: what is the real effectiveness of endoscopic sphincterotomy?]

To assess real efficacy of endoscopic sphincterotomy in the setting of postcholecistectomy choledocolitiasis (i.e., without excluding for analysis any patient referred for the procedures) traditionally the evaluation has been done after excluding those cases in which the procedure failed or was not attempted.

Retrospective analysis of a series of cholecystectomized patients with choledocolithiasis. Patients were included for analysis on an "intention to treat" basis, without excluding cases in which the procedure either was not attempted or failed.

Out of 122 patients (47.1%) with a firm diagnosis of choledocholithiasis, endoscopic sphincterotomy was performed in 108 (88.5%); in the remaining 13 (10.7%), it was not attempted due to various reasons (among other, five cases of unsuccessful diagnostic cholangiography). In one patient, with a previous surgical sphincteroplasty, calculi were directly extracted. On the whole, stone extraction/expulsion was achieved in 92 cases (including the one patient with previous surgical sphincteroplasty), what represents a success rate of 75.4% on 122 cholecistectomized patients with known choledocolitiasis. Morbidity and mortality reached 9% and 1%, respectively.

If each referred patient is included for analysis of the results of endoscopic sphincterotomy for postcholecistectomy choledocolithiasis (independently of technical success), the therapeutic yield of this procedure lowers significantly compared with the usual estimations.