Divergent effects of endoscopic sphincterotomy on the long-term outcome of hepatolithiasis.

BACKGROUND: The long-term value of endoscopic sphincterotomy in patients with hepatolithiasis has not been established.

METHODS: Long-term clinical effects of endoscopic sphincterotomy on hepatolithiasis were determined in 57 patients. All patients had sphincterotomy to remove their common bile duct stones. Intrahepatic stones were removed completely in 21 patients, while the stones partly remained in 36 patients despite combined use of surgery and/or percutaneous trans-hepatic choledochoscopy. Three patients of the latter group spontaneously passed all the remaining stones soon after the sphincterotomy.

RESULTS: Follow-up at 66 to 183 months (mean, 114 months) was available in 54 patients (94.7%). Late complications occurred in 10 patients with the remaining stones, including seven cases of cholangitis (two fatalities) and three of liver abscess (one fatality). In contrast, those with complete clearance developed no complications.

CONCLUSIONS: Endoscopic sphincterotomy has divergent effects on the long-term outcome of patients with hepatolithiasis. Every effort should be made to remove the intrahepatic stones as completely as possible shortly after sphincterotomy if the patient is to be managed endoscopically and adverse effects are to be avoided.