Endoscopic sphincterotomy for common bile duct stones in younger patients

Most follow-up studies of patients with common bile duct stones treated with endoscopic sphincterotomy include older patients. Therefore, the aim of the present study was to do a medium-term follow-up of patients under the age of 60 years, who underwent endoscopic sphincterotomy and removal of common bile duct stones.

Eighty-six (68 women) consecutive patients less than 60 years of age (median age 47 years) were evaluated. The median observation time after endoscopic sphincterotomy was 27.1 months. Complete follow-up was accomplished in 80 patients.

Twenty-five patients had undergone cholecystectomy prior to the endoscopic sphincterotomy. Sixty-one patients were discharged after endoscopic sphincterotomy with gallbladder left in situ. Cholecystectomy was not needed in 27 patients, of whom 23 had gallbladder stones. In 13 of 61 patients subsequent elective cholecystectomy was planned at the time of endoscopic sphincterotomy. Recurrent attacks of biliary colic required elective cholecystectomy in another thirteen patients. Acute cholecystectomy was undertaken in eight patients due to acute cholecystitis (n = 4) or biliary colic (n = 4). Seven of eight acute cholecystectomies were performed within 152 days after the endoscopic sphincterotomy. The overall median time until cholecystectomy was 51 days (25-75 percentiles, 23-103 days).

One third of the patients had been cholecystectomized prior to the endoscopic treatment of their common bile duct stones. Nearly half of the young patients discharged after endoscopic sphincterotomy for common bile duct stones with the gallbladder left in situ at the time of endoscopic sphincterotomy managed well without any need for cholecystectomy.