[Choledocholithiasis in non-cholecystectomized patients: endoscopic sphincterotomy and afterwards ... cholecystectomy?].

Abstract

Choledocholithiasis in patients with a gallbladder "in situ" is presently one of the most frequent indications of endoscopic sphincterotomy. The crucial problem of these patients is whether or not they require eventual cholecystectomy to avoid the risks of potential complications of cholelithiasis. Of the 39 patients (mean age 80.1 +/- 8.2 years) with choledocholithiasis and gallbladder "in situ" released from this hospital from October 1979 to December 1985 after a successful endoscopic sphincterotomy (expulsion, spontaneous or not, of gallstones), 33 (84.6%) have been followed-up for an average of 41.5 +/- 20.8 months (7-92 range). During this time only one patient (3%) developed acute cholecystitis that required cholecystectomy, and two (6%) denoted mild pains in the right upper quadrant, while the other 30 (91%) remained asymptomatic. Over these years 10 patients (30.3%) died from nonbiliary causes. In conclusion, in elderly or high surgical risk patients who present choledocholithiasis and gallbladder "in situ", endoscopic sphincterotomy is effective. Later cholecystectomy to prevent the complications of cholelithiasis would not be justified as a routine measure in most of these patients.