Details

Autor(en) / Beteiligte

• Yasuda, Ichiro, MD, PhD
• Fujita, Naotaka, MD, PhD
• Maguchi, Hiroyuki, MD, PhD
• Hasebe, Osamu, MD, PhD
• Igarashi, Yoshinori, MD, PhD
• Murakami, Akihiko, MD, PhD
• Mukai, Hidekazu, MD, PhD
• Fujii, Tsuneshi, MD, PhD
• Yamao, Kenji, MD, PhD
• Maeshiro, Kensei, MD, PhD
• Tada, Tomoko, MD, PhD
• Tsujino, Takeshi, MD, PhD
• Komatsu, Yutaka, MD, PhD

Titel

Long-term outcomes after endoscopic sphincterotomy versus endoscopic papillary balloon dilation for bile duct stones

Ist Teil von

• Gastrointestinal endoscopy, 2010-12, Vol.72 (6), p.1185-1191

Ort / Verlag

Maryland heights, MO: Mosby, Inc

Erscheinungsjahr

2010

Quelle

MEDLINE

Beschreibungen/Notizen

• Objective Endoscopic sphincterotomy (ES) is a well-established standard method for treating common bile duct stones. However, biliary sphincter function is impaired after the treatment, and this may influence the long-term outcomes. In this study, we aimed to compare the long-term outcomes after ES with those after endoscopic papillary balloon dilation (EPBD) because the latter procedure is expected to preserve biliary sphincter function better than ES. Design A prospective follow-up of the original cohort in a previously randomized, controlled trial to compare the early outcomes after ES and EPBD. Setting Eleven centers, including 6 clinical practices and 5 academic institutions. Patients A total of 282 patients with common bile duct stones were randomly selected to undergo ES (n = 144) or EPBD (n = 138) in the previous study. Interventions ES or EPBD. Main Outcome Measurements Complications after ES or EPBD occurring during long-term follow-up. Results The patients were followed up annually after the treatment. The median duration of the follow-up was 6.7 years. Morbidity was observed in 36 (25.0%) and 14 (10.1%) of the patients who underwent ES and EPBD, respectively ( P = .0016). Kaplan-Meier analysis revealed a significantly higher incidence of biliary complications in the ES group than in the EPBD group ( P = .0011). Multivariate analysis showed that ES, periampullary diverticulum, and in situ gallbladder stones were independent risk factors for stone recurrence. Conclusions During long-term follow-up, patients who underwent ES had significantly more biliary complications than those who underwent EPBD. The biliary sphincter dysfunction after ES results in additional late complications.