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. 1991 Jun;213(6):627–634. doi: 10.1097/00000658-199106000-00013

Choledocholithiasis. Endoscopic sphincterotomy or common bile duct exploration.

S C Stain 1, H Cohen 1, M Tsuishoysha 1, A J Donovan 1
PMCID: PMC1358591  PMID: 2039294

Abstract

A prospective randomized trial was conducted of preoperative endoscopic sphincterotomy and surgery (ES&S) or surgery alone (SA) in 52 patients with cholecystolithiasis and choledocholithiasis that were candidates for elective surgery. After ES&S 65% of patients were stone free. Eighty-eight per cent of patients with SA were stone free after surgery (p less than 0.05). Three patients in each group had residual stones at the completion of the operation. Five of these six had more than 20 common bile duct (CBD) stones. There was one episode of major hemorrhage in a patient in each group and no deaths. Costs were essentially equal for the individual patient with a successful ES as compared to SA. Societal costs of a program of preoperative endoscopic retrograde cholangiopancreatography and ES would be higher because of the cost of screening for patients with CBD stones. These results do not support preoperative ES as a technique for clearance of the CBD of stones on the basis of efficacy, morbidity rate, or cost.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brendel W., Enders G. Shock waves for gallstones: animal studies. Lancet. 1983 May 7;1(8332):1054–1054. doi: 10.1016/s0140-6736(83)92687-9. [DOI] [PubMed] [Google Scholar]
  2. Burhenne H. J. Complications of nonoperative extraction of retained common duct stones. Am J Surg. 1976 Mar;131(3):260–262. doi: 10.1016/0002-9610(76)90111-2. [DOI] [PubMed] [Google Scholar]
  3. Classen M., Demling L. Endoskopische Sphinkterotomie der Papilla Vateri und Steinextraktion aus dem Ductus choledochus. Dtsch Med Wochenschr. 1974 Mar 15;99(11):496–497. doi: 10.1055/s-0028-1107790. [DOI] [PubMed] [Google Scholar]
  4. Cotton P. B. Endoscopic management of bile duct stones; (apples and oranges). Gut. 1984 Jun;25(6):587–597. doi: 10.1136/gut.25.6.587. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Cotton P. B., Vallon A. G. British experience with duodenoscopic sphincterotomy for removal of bile duct stones. Br J Surg. 1981 Jun;68(6):373–375. doi: 10.1002/bjs.1800680602. [DOI] [PubMed] [Google Scholar]
  6. Davidson B. R., Neoptolemos J. P., Carr-Locke D. L. Endoscopic sphincterotomy for common bile duct calculi in patients with gall bladder in situ considered unfit for surgery. Gut. 1988 Jan;29(1):114–120. doi: 10.1136/gut.29.1.114. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Escourrou J., Cordova J. A., Lazorthes F., Frexinos J., Ribet A. Early and late complications after endoscopic sphincterotomy for biliary lithiasis with and without the gall bladder 'in situ'. Gut. 1984 Jun;25(6):598–602. doi: 10.1136/gut.25.6.598. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Feliciano D. V., Mattox K. L., Jordan G. L., Jr The value of choledochoscopy in exploration of the common bile duct. Ann Surg. 1980 May;191(5):649–654. doi: 10.1097/00000658-198005000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Glenn F. Retained calculi within the biliary ductal system. Ann Surg. 1974 May;179(5):528–539. doi: 10.1097/00000658-197405000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Kawai K., Akasaka Y., Murakami K., Tada M., Koli Y. Endoscopic sphincterotomy of the ampulla of Vater. Gastrointest Endosc. 1974 May;20(4):148–151. doi: 10.1016/s0016-5107(74)73914-1. [DOI] [PubMed] [Google Scholar]
  11. Koch H., Rösch W., Walz V. Endoscopic lithotripsy in the common bile duct. Gastrointest Endosc. 1980 Feb;26(1):16–18. doi: 10.1016/s0016-5107(80)73252-2. [DOI] [PubMed] [Google Scholar]
  12. Leese T., Neoptolemos J. P., Baker A. R., Carr-Locke D. L. Management of acute cholangitis and the impact of endoscopic sphincterotomy. Br J Surg. 1986 Dec;73(12):988–992. doi: 10.1002/bjs.1800731214. [DOI] [PubMed] [Google Scholar]
  13. Leow C. K., Thompson M. H. Endoscopic papillotomy without cholecystectomy for bile duct stones. Ann R Coll Surg Engl. 1986 Nov;68(6):310–311. [PMC free article] [PubMed] [Google Scholar]
  14. Martin D. F., Tweedle D. E. Endoscopic management of common duct stones without cholecystectomy. Br J Surg. 1987 Mar;74(3):209–211. doi: 10.1002/bjs.1800740320. [DOI] [PubMed] [Google Scholar]
  15. McSherry C. K., Glenn F. The incidence and causes of death following surgery for nonmalignant biliary tract disease. Ann Surg. 1980 Mar;191(3):271–275. doi: 10.1097/00000658-198003000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Miller B. M., Kozarek R. A., Ryan J. A., Jr, Ball T. J., Traverso L. W. Surgical versus endoscopic management of common bile duct stones. Ann Surg. 1988 Feb;207(2):135–141. doi: 10.1097/00000658-198802000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Murray W. R., LaFerla G., Fullarton G. M. Choledocholithiasis--in vivo stone dissolution using methyl tertiary butyl ether (MTBE). Gut. 1988 Feb;29(2):143–145. doi: 10.1136/gut.29.2.143. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Neoptolemos J. P., Carr-Locke D. L., Fossard D. P. Prospective randomised study of preoperative endoscopic sphincterotomy versus surgery alone for common bile duct stones. Br Med J (Clin Res Ed) 1987 Feb 21;294(6570):470–474. doi: 10.1136/bmj.294.6570.470. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Neoptolemos J. P., Carr-Locke D. L., London N. J., Bailey I. A., James D., Fossard D. P. Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones. Lancet. 1988 Oct 29;2(8618):979–983. doi: 10.1016/s0140-6736(88)90740-4. [DOI] [PubMed] [Google Scholar]
  20. Neoptolemos J. P., Davidson B. R., Shaw D. E., Lloyd D., Carr-Locke D. L., Fossard D. P. Study of common bile duct exploration and endoscopic sphincterotomy in a consecutive series of 438 patients. Br J Surg. 1987 Oct;74(10):916–921. doi: 10.1002/bjs.1800741014. [DOI] [PubMed] [Google Scholar]
  21. Pappas T. N., Slimane T. B., Brooks D. C. 100 consecutive common duct explorations without mortality. Ann Surg. 1990 Mar;211(3):260–262. [PMC free article] [PubMed] [Google Scholar]
  22. Sivak M. V., Jr Endoscopic management of bile duct stones. Am J Surg. 1989 Sep;158(3):228–240. doi: 10.1016/0002-9610(89)90256-0. [DOI] [PubMed] [Google Scholar]
  23. Thistle J. L., May G. R., Bender C. E., Williams H. J., LeRoy A. J., Nelson P. E., Peine C. J., Petersen B. T., McCullough J. E. Dissolution of cholesterol gallbladder stones by methyl tert-butyl ether administered by percutaneous transhepatic catheter. N Engl J Med. 1989 Mar 9;320(10):633–639. doi: 10.1056/NEJM198903093201004. [DOI] [PubMed] [Google Scholar]
  24. Tompkins R. K. Laparoscopic cholecystectomy. Threat or opportunity? Arch Surg. 1990 Oct;125(10):1245–1245. doi: 10.1001/archsurg.1990.01410220029002. [DOI] [PubMed] [Google Scholar]
  25. Traverso L. W. Carl Langenbuch and the first cholecystectomy. Am J Surg. 1976 Jul;132(1):81–82. doi: 10.1016/0002-9610(76)90295-6. [DOI] [PubMed] [Google Scholar]
  26. Van Stiegmann G., Pearlman N. W., Goff J. S., Sun J. H., Norton L. W. Endoscopic cholangiography and stone removal prior to cholecystectomy. A more cost-effective approach than operative duct exploration? Arch Surg. 1989 Jul;124(7):787–790. doi: 10.1001/archsurg.1989.01410070037008. [DOI] [PubMed] [Google Scholar]
  27. Way L. W., Admirand W. H., Dunphy J. E. Management of choledocholithiasis. Ann Surg. 1972 Sep;176(3):347–359. doi: 10.1097/00000658-197209000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Worthley C. S., Toouli J. Gallbladder non-filling: an indication for cholecystectomy after endoscopic sphincterotomy. Br J Surg. 1988 Aug;75(8):796–798. doi: 10.1002/bjs.1800750825. [DOI] [PubMed] [Google Scholar]
  29. Zimmon D. S. Alternatives to cholecystectomy and common duct exploration. Am J Gastroenterol. 1988 Nov;83(11):1272–1273. [PubMed] [Google Scholar]

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