3406 Does prophylactic endoscopic sphincterotomy (es) prevent recurrent biliary problems in patients with gallstones and a normal cholangiogram?

• Published in: Gastrointestinal endoscopy Vol. 51; no. 4; p. AB84
• Main Authors: Johnston, Simon D., Lim, Peik, Collins, John Sa, Watson, Peter, Tham, Tony Ck
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2000
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(00)14106-9

Background: Patients with gallbladder stones presenting with jaundice, deranged liver function tests (LFTs), dilated ducts on imaging or pancreatitis as possible indicators of common bile duct (CBD) stones usually undergo ERCP. Except for pancreatitis, it is unclear whether prophylactic ES should be performed in patients with a normal cholangiogram, in whom cholecystectomy is not proposed. Aim: To determine if prophylactic ES can prevent further biliary problems if a cholecystectomy is not planned for patients with suspected CBD stones and a normal cholangiogram. Methods: Endoscopic databases at two centers (Royal Victoria and Ulster Hospitals) were searched for patients with gallbladder stones presenting with jaundice, deranged LFTs or dilated ducts on ultrasound (USS), in whom a cholecystectomy was not planned. Endoscopic findings were noted. A telephone questionnaire was performed on all patients, or their carers if possible, to determine the frequency of recurrent biliary problems or repeat investigations. One center routinely performed prophylactic ES while the other did not. Results from the two groups were compared. Results: 41 patients met the inclusion criteria of whom 20 (7 male) had a ES and 21 (12 male) did not. The frequency of pre-ERCP jaundice (14 v 12; p=0.3), deranged LFTs (18 v 16; p=0.22), abdominal pain (15 v 15; p=0.8), dilated ducts (9 v 12; p=0.39) did not differ between the two groups. Post- ERCP recurrent abdominal pain (5 v 3; p=0.39), jaundice (3 v 1; p=0.28), pancreatitis (0 v 1; p=0.32) and repeat USS (2 v 1; p=0.52) or ERCP (1 v 1; p=0.97) did not differ between the two groups. Conclusions: Patients with gallstones and suspected CBD stones and a normal cholangiogram should not have a prophylactic sphincterotomy as it did not reduce the incidence of recurrent biliary problems.