| AIMS:Over the last decade,the result of surgical choledochotomy for choledocholithiasis have improved with immediate and long-term morbidity rates compareable to those for endoscopic sphinterotomy(EST).However,EST followed by stone extraction would still constitute the treatment of choice for post-cholecyctectomy choledocholithiasis,since it is simple,safer,and has a high success rate with lower costs compared with surgical therapy.To assess short term results of papilla functional status after endoscopic sphincterotomy(EST) with thin barium meal examination.This study was conducted to examine the long-term follow-up(more than 1 month) after treatment of patients with choledocholithiasis by sphinterotomy.Later complication after EST occur in up to 10%of cases.Most of which are managed conservatively. Long-term sequelae related to EST include recurrent choledocholithiasis,papillary stenosis, changitis,and possibly cholecyctitis and malignant degeneration.METHODS:From August,2001 to December,2003,eighty-nine patients were included for endoscopic sphincterotomy.Size of EST was(0.5～1.5) cm.Patients were prospectively followed on the term period(7 days,6 months and 1 year) by clinical and thin barium(100/100 V/W) meal examination which would be observed biliary gas and barium reflux from duodenal papilla.1251 inpatients who were treated for choledocholithiasis from 1999 to 2006 based on Changhai hospital,Shanghai,China.were selected as subjects and monitored for a period ranging from 1 mouth to 7 years.The patients were divided into 3 groups:EST group (patients whose stones were removed by endoscopic sphincterotomy);T-tube drainage group(patients who had undergone T-tube drainage);and choledochoduodenostomy group (patients who had undergone choledochoduodenostomy).All patients were follow-up in the period of more than 30 days.RESULTS:The patient number of gas reflux shows:19 of 89 cases(21.2%) in one week,5 of 36 cases(13.9%) in six months,3 of 23 cases(13.0%) in one year;barium reflux with thin barium meal examination shows:11 of 89 cases(12.3%) in one week,3 of 36 cases(8.3%) in six months,2 of 23 cases(8.7%) in one year.In the size of EST more than 1.1 cm,these were nine patients(47.3%) with gas reflux,and seven patients(36.8%) with barium reflux,and five patients with gas barium mix reflux.6 month and 1 year after sphincterotomy,includes EST size 1.2 cm,2 cases and 1.5 cm,3 cases.Of all the 1251 patients on three groups.There were 191 patients(15.3%) with various kinds of complication long-term follow-up.Choledocholithiasis recurred in 72 of the cases(5.86%).The diameter of the common bile duct measured during the initial treatment was more dilated in patients with recurrent lithiasis(15.3±5.2) mm than in patients without any recurrence(11.8±2.9) mm,P=0.02.Choledochoduodenostomy was performed in 23 cases for the purpose of preventing any recurrence.The recurrent rate in common bile duct stone was analyzed in 1228 cases.68 of 1194 patients with EST group were recurrence,the recurrence rate was 5.36%;and 4 of 34 with T-tube drainage group, recurrence rate was 11.76,P=0.03.Of 1194 patients after EST,177(14.8%) had a complication,including cholangitis in 117(9.86%),recurrent lithiasis in 68(5.70%),pancreatitis in 14(1.17%),duodenal papilla stenosis in 11(0.91%),and biliary malignant tumor in 6(0.50%).CONCLUSION:Thin barium meal examination of papilla function after endoscopic sphincterotomy is an efficient procedure.Incidence rate of gas reflux and thin barium reflux were closely related to the size of EST.The rate of complications after endoscopic biliary sphincterotomy can vary widely in different circumstances and is primarily related to the indication for the procedure and to endoscopic technique.Although choledocholithotomy and T-tube drainage,including open and laparoscopic surgery,is presently a common procedure for choledocholithiasis,this procedure will not necessarily prevent a recurrence of the disease.So,EST is a best selection for patients with choledocholithiasis.
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