Pros and Cons of Gallbladder in Situ in Patients with Choledocholithiasis after Endoscopic Sphincterotomy

Endoscopic sphincterotomy was performed in 198 patients with symptoms related to the presence of common duct stones. The common duct was cleared of stones using Dormia basket and or balloon extractor in 180 patients (91%). These 180 patients (age range from 24 to 93 years, average 59 years) were followed up 6 to 48 months (mean 22 months) after endoscopic sphincterotomy. Seventy seven patients were cholecystectomized while 103 patients had intact gallbladder (32 patients with gallstones, 71 without gallstones). Immediate complications associated with EST occurred in 9 patients (4.5%) (5 bleeding, 3 cholangitis, 1 pancreatitis), with one death secondary to pancreatic abscess. EST is a safe and effective method in the treatment of common bile duct stones, especially in high-risk patients who cannot tolerate surgical intervention. Recurrent biliary symptoms were encountered in 24 patients (13%), 10 in the cholecystectomized group and 14 in patients with intact gallbladder. Eight of 14 patients had acalculous gallbladder, while the other 6 patients had gallstones. Symptoms related to the gallbladder inflammation was not encountered in patients without gallstones. However, 6 patients with calculous gallbladder had an episode of cholecystitis within 2 years after EST. Three of these patients required cholecystectomy, but the remaining three responded well by conservative treatment. We therefore recommend cholecystectomy to those patients with common bile duct stone associated with gallstones after EST.