Long-term risk for acute pancreatitis, cholangitis, and malignancy more than 15 years after endoscopic sphincterotomy: a population-based study.

BACKGROUND AND STUDY AIMS: It has been suggested that endoscopic sphincterotomy predisposes a patient to cholangitis, pancreatitis, and carcinoma in the pancreaticobiliary tract in the long term. Previous studies have shown an increased risk for acute cholangitis and pancreatitis but not for carcinoma. The aim of this study was to analyze these risks by conducting a long-term follow-up study of patients who underwent treatment for gallstone disease, comparing patients who underwent endoscopic sphincterotomy with those who did not.

PATIENTS AND METHODS: A cohort of 1113 Swedish patients who were treated with endoscopic sphincterotomy between 1977 and 1990 for common bile duct stones was compared with two age-and sex-matched control groups with a history of cholecystectomy or cholecystectomy and cholangiotomy.

RESULTS: Over a median follow-up of more than 15 years after endoscopic sphincterotomy, the hazard ratio for endoscopic sphincterotomy versus cholecystectomy was 5.5 (95% confidence interval [CI] 3.5-8.4) for cholangitis and 4.9 (95%CI 2.8-8.6) for pancreatitis. The hazard ratio for endoscopic sphincterotomy versus cholangiotomy was 1.7 (95%CI 1.3-2.4) for cholangitis and 1.5 (95%CI 1.0-2.4) for pancreatitis. There was no significant increase in risk for malignant diagnoses.

CONCLUSION: Patients who underwent endoscopic sphincterotomy for choledocholithiasis had an increased risk for acute pancreatitis and cholangitis in the long term compared with those not treated with endoscopic sphincterotomy. There was no increase in risk for malignancy in the pancreaticobiliary tract.