Long-term results (7 to 10 years) of endoscopic papillotomy for choledocholithiasis. Multivariate analysis of prognostic factors for the recurrence of biliary symptoms

被引：246

作者：

Pereira-Lima, JC ^{[1
]}

Jakobs, R ^{[1
]}

Winter, UH ^{[1
]}

Benz, C ^{[1
]}

Martin, WR ^{[1
]}

Adamek, HE ^{[1
]}

Riemann, JF ^{[1
]}

机构：

[1] Univ Mainz, Dept Med Gastroenterol Hepatol C, Klinikum Ludwigshafen, Acad Teaching Hosp, Ludwigshafen, Germany

来源：

GASTROINTESTINAL ENDOSCOPY | 1998年 / 48卷 / 05期

关键词：

D O I：

10.1016/S0016-5107(98)70085-9

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background: The long-term outcome after endoscopic papillotomy is poorly defined. The aim of this study was to determine the long-term results of this method in the treatment of common duct calculi and to determine which prognostic factors are associated with the relapse of biliary symptoms. Methods: Between 1985 and 1988, 223 consecutive (149 women, mean age 67.9 years) patients underwent endoscopic papillotomy for duct stones; 127 had already undergone cholecystectomy or underwent this operation during the same hospitalization. Follow-up data were obtained retrospectively from the patients and patients' relatives and general practitioners. Results: The procedure was successful in 217 of 223 cases (97%), of which 203 were followed-up; 2 patients died in the first month after treatment (0.89%). Mean follow-up for the 201 patients was 6.2 years, during which 31 relapsed (15%). Three significant prognostic factors for late complications were identified in a multivariate analysis. The recurrence rate of biliary symptoms in patients who were left with an in situ gallbladder was 20.2%, and 11% for those whose gallbladder was removed (p = 0.04). Patients with a bile duct 15 mm or greater in diameter were more prone to recurrence of symptoms than those with a bile duct 10 mm or less in diameter (41% vs. 10%, p = 0.025) and were especially at higher risk to develop recurrent stones (19.5% vs. 4.9%, p = 0.019). Stone recurrence, but not biliary symptoms as a whole, was more frequent in patients with a peripapillary diverticulum (p = 0.035). Conclusions: The long-term results of endoscopic papillotomy are comparable with those of surgical techniques. The prognostic factors associated with relapse of biliary symptoms as a whole are gallbladder left in situ and choledochal diameter. Bile duct size and peripapillary diverticula are associated with recurrent bile duct stones.

引用

页码：457 / 464

页数：8

共 47 条

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