Gómez CX, Pérez BB, Rendón CE, López AME, González-Angulo RA, Rodríguez VG, Fernández CE, Zamorano OY, Arizmendi GA

Language: Spanish
References: 22
Page: 178-183
PDF size: 101.00 Kb.

ABSTRACT

Background: Residual choledocholithiasis regard between 5 to 12% of the cholecystectomy. However, surgical exploration of the common bile duct do not exclude the possibility of retained stones. Endoscopic sphincterotomy (ERCP-ES) followed by the removal of stones had showed to be a secure and effective procedure. Objective: The aims of the study were to report the experience of ERCP-ES in the treatment of residual choledocholithiasis at our hospital. Material and methods: Retrospective and descriptive studies from March 1996 to September 2003, that included patients that come to the Endoscopy Unit of the General Hospital “Dr. Manuel Gea González” with A) Jaundice postcholecystectomy by retained stones; B) Jaundice between the first two years of cholecystectomy and bile duct surgery and C) Cholangiography by T-tube with residual calculi. Analyze demographic characteristics, endoscopic approach, number of retained stones, success of the procedure, therapeutic options in difficult stones and complications. Results: From March 1996 to September 2003 were selected 319 patients with residual choledocholithiasis. Female sex predominated in 81.5%, age average was 42 years with range from 18 to 72 years. The 35% (n = 111) of the cases have T-tube. Combine approach 26% (n = 84), guide cannulation 69% (n = 220), precut papillotomy 4% (n = 13) and unsuccessful cannulation 0.6% (n = 2). Endoscopic sphincterotomy was performance in 99.3% (n = 317). Nineteen patients (6%) required biliary stenting, 2 by impacted stones in left hepatic duct and 17 by large or impacted bile duct stones, that continue treatment with ursodeoxycholic acid and second CPRE in the following 4 or 6 months, with success mechanical lithotripsy in 6 patients and electrohydraulic lithotripsy in 3. The residual lithiasis was successfully treated in 314 patients (98.4%) and only five (1.5%) needed common bile duct exploration. Eight patients was no serious procedure-related complications, that included 4 self-limited pancreatitis and 4 hemorrhage. There were no mortality. Conclusion: The endoscopic sphincterotomy for the treatment of residual choledocholithiasis show good results and low morbility. When is not possible to remove it in the first procedure, biliary stenting and stones fragmentation increase the success.

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