Divergent effects of endoscopic sphincterotomy on the long-term outcome of hepatolithiasis☆,☆☆,★,★★,♢
Section snippets
MATERIALS AND METHODS
Fifty-seven patients with intrahepatic stones underwent ES for the treatment of coexistent common bile duct stones. Twenty-five patients were men and 32 women. The age ranged from 33 to 83 years with a mean of 56.7 years. The presence of the intrahepatic stones was known before ES in 32 patients (Group I), whereas it was demonstrated by post-ES investigations in the remaining 25 patients (Group II). ES was performed on an emergency basis to remove the common bile duct stones associated with
RESULTS
Follow-up data were available in 54 of 57 patients (95%). The mean follow-up period was 114 months (range, 66 to 183 months). Twenty-one patients were dead; 33 were alive. Causes of death were cholangiocarcinoma in 3 patients, late cholangitis in 2, liver abscess in 1, unknown in 2, and not related to hepatolithiasis in the other 13 (Table 1).
Intrahepatic stones had been completely cleared in 18 patients, whereas stones were only partially removed in 36 patients. Three patients in the latter
DISCUSSION
The present study demonstrates that ES has divergent effects on the long-term clinical outcome of patients with intrahepatic stones. Of 36 patients with incomplete clearance of the intrahepatic stones at the time of completion of ES and subsequent removal of common bile duct stones, 3 patients spontaneously passed all the remaining stones. Conversely, 10 of the 36 patients developed the potentially fatal complications of cholangitis (7) and liver abscess (3). The complications actually led to
Acknowledgements
We conclude that patients with intrahepatic stones after ES are at significant risk for subsequent biliary infection. Additional endoscopic, percutaneous, or surgical therapy is recommended to avoid serious cholangitis events associated with persistant intrahepatic stones.
References (21)
- et al.
Endoscopic sphincterotomy of the ampulla of Vater
Gastrointest Endosc
(1974) Duodenoscopic sphincterotomy and gallstone removal
Gastroenterology
(1977)- et al.
Nonoperative removal of giant common bile duct calculi
Am J Surg
(1988) - et al.
Cholangiography of intrahepatic bile ducts in hepatolithiasis by endoscopic placement of an indwelling balloon catheter
Gastrointest Endosc
(1985) - et al.
Effects of sphincteroplasty and endoscopic sphincterotomy on the bacteriologic characteristics of the common bile duct
Am J Surg
(1985) - et al.
Hepatolithiasis in East Asia: retrospective study
Dig Dis Sci
(1986) - et al.
Intrahepatic stones: a clinical study
Ann Surg
(1972) - et al.
The surgical management of primary intrahepatic stones
Br J Surg
(1982) - et al.
Experience with routine postoperative choledochoscopy via the T-tube tract
World J Surg
(1978) - et al.
Value of percutaneous transhepatic cholangioscopy (PTCS)
Surg Endosc
(1988)
Cited by (20)
Chapter 39 - Intrahepatic stones
2016, Blumgart's Surgery of the Liver, Biliary Tract and Pancreas: Sixth EditionSecondary Sclerosing Cholangitis. Pathogenesis, Diagnosis, and Management.
2013, Clinics in Liver DiseaseCitation Excerpt :Surgery focuses on drainage and exploration of the bile ducts. Endoscopic intervention may also be used when needed, and long-term drainage may be the only option in a few patients with widespread disease.15,51,52 Conversely, therapeutic options in patients with AIDS cholangiopathy are limited, because none have been shown to be beneficial in improving survival.
Left-sided hepatic resection for hepatolithiasis: A longitudinal study of 110 patients
2012, HPBCitation Excerpt :Treatment options include surgical treatment with biliary decompression and/or hepatic resection as the first approach.14,15 Non-surgical procedures such as percutaneous transhepatic lithotriphy or endoscopic therapy are usually reserved to treat stone recurrences.16,17 Morbidity and mortality rates for hepatic resection have decreased significantly in the last decade.5,18
Liver resection as the definitive treatment for unilateral non-oriental primary intrahepatic lithiasis
2006, American Journal of SurgeryCitation Excerpt :Hepatic resection for the treatment of hepatolithiasis has been reported to be associated with a low incidence of long-term stone recurrence or recurrent cholangitis [12–17]. The global rate of 7.4% of late complications in our series is relatively low when compared with recurrent/residual disease rates ranging between 20% and 40% reported in most studies after percutaneous cholangioscopic lithotripsy, or endoscopic or other surgical approaches such as bilioenteric anastomosis without hepatic resection [6–10,17,18]. In this study, to our knowledge the largest western PIHL series, the indications for resection were irreversible parenchyma or biliary lesions.
Endoscopic intervention for hepatolithiasis associated with sharp angulation of right intrahepatic ducts
2003, Gastrointestinal EndoscopyIs peripapillary choledochoduodenal fistula an indication for endoscopic sphincterotomy?
2001, Gastrointestinal Endoscopy
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From the Departments of Surgery I, Kyushu University Faculty of Medicine, and Fukuoka University School of Medicine, Fukuoka, Japan.
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Reprint requests: Masao Tanaka, MD, Surgery I, Kyushu University Faculty of Medicine, Fukuoka 812, Japan.
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