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

• Published in: Gastrointestinal endoscopy 2010-12, Vol.72 (6), p.1185-1191
• Main Authors: 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
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Catheterization; Cohort Studies; Female; Follow-Up Studies; Gallstones - therapy; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Japan; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Postoperative Complications - etiology; Prospective Studies; Sphincterotomy, Endoscopic
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2010.07.006

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.