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Role of endoscopic sphincterotomy alone in patients with choledocholithiasis and cholelithiasis
1Department of Surgery, Toronto Hospital, Ont.
Objective:
To study the long-term effects of endoscopic sphincterotomy alone in elderly patients with choledocholithiasis and cholelithiasis.
Design:
A chart review.
Setting:
A university-affiliated hospital.
Patients:
Twenty-one patients over 60 years of age, who presented with cholecystitis, jaundice or cholangitis. The follow-up ranged from 1 to 5 years (mean 3.51 years).
Intervention:
Endoscopic sphincterotomy.
Main Outcome Measures:
The occurrence of postsphincterotomy pancreatitis, cholangitis and cholecystitis.
Results:
In the early postsphincterotomy period, 3 of the 21 patients had pancreatitis, which was treated conservatively. One patient had cholangitis. In this patient the initial sphincterotomy did not clear the common bile duct of all stones, but a repeat procedure was successful and the cholangitis resolved. One patient had mild cholecystitis that responded to conservative therapy. In the long term, 9 of the 21 patients had cholecystitis. This was treated conservatively in six patients, but three required cholecystectomy. One patient had choledocholithiasis requiring exploration of the common bile duct.
Conclusions:
In elderly debilitated patients with cholelithiasis and choledocholithiasis, endoscopic sphincterotomy alone may be adequate therapy. However, patients presenting with cholangitis and cholelithiasis may eventually require cholecystectomy.
