Risk factors predictive of late complications after endoscopic sphincterotomy for bile duct stones: Long-term (more than 10 years) follow-up study

OBJECTIVE: Widespread use of laparoscopic cholecystectomy has extended the indications for endoscopic sphincterotomy (ES) to young patients with choledocholithiasis; however, long-term results of ES and risk factors for late complications are largely unknown. METHODS: Between 1977 and 1990, 145 patients aged 60 yr or younger underwent ES for choledocholithiasis. Longterm outcomes of ES were investigated in the year 2000, and prognostic factors for late complications were multivariately analyzed. RESULTS: Long-term information was available in 135 cases (93.1%), with a median overall follow-up duration of 14.5 yr (range, 6.5-22.3 yr). There were neither biliary malignancies nor deaths attributable to biliary disease. Sixteen patients (11.9%) developed late complications, including choledochal complications (stone recurrence and/or cholangitis; 14 patients) and acute cholecystitis (two of 32 patients with the gallbladder in situ). Multivariate analysis identified two independent risk factors for choledochal complications: bile duct diameter greater than or equal to 15 mm and brown pigment stones at the initial ES. Choledochal complications were endoscopically manageable. All recurrent stones were brown pigment stones. CONCLUSIONS: Approximately 12% of patients develop late complications after ES, but retreatment with ERCP is effective. ES is a reasonable alternative even in young patients with choledocholithiasis. Careful follow-up is necessary, however, particularly for patients with a dilated bile duct or brown pigment stones. (C) 2002 by Am. Coll. of Gastroenterology.