Long-term follow-up after endoscopic sphincterotomy (EST)

Abstract

Long-term results after endoscopic sphincterotomy (EST) revealed disappearance or improvement of symptoms in 92.0%. The symptoms remained unchanged in 6.2% and deteriorated in only 1.8%. X-ray follow-up studies showed concrement-free bile ducts in 85.2%, recurrent stones in 11.3%, and a stenosis of EST in 3.5%. Satisfactory long-term results depend on the indication for EST. The results of EST for choledocholithiasis are much better than for papillary stenosis (symptom-free or improved = 91.7%: 83.7%, unchanged = 6.4%: 14.3%, deteriorated = 1.9%: 2.0%). An EST-related stenosis was more than five times more frequent (16.8%: 2.9%) in papillary stenosis than choledocholithiasis. A gallbladder in situ does not seem to be an additional risk factor after EST. Subsequent cholecystectomy was performed in only 16.2% (routinely and elective), and in only 2.0% as an emergency procedure. In approximately 50% of the cases aerobilia and reflux, and in about 100% bacteriocholia, are observed after EST. When the free outflow of bile is ensured, it is not probable that late secondary diseases will develop.