Recently there have been many changes on biliary stone disease treatment due to the rapid development of laparoscopic and endoscopic techniques. Sometimes we face difficulties in selecting appropriate treatment modalities for stone stone
diseases.
The
endoscopic sphincterotomy(EST) has been one of the standard maneuvers for treating biliary stone diseases. The purpose of this study is to evaluate its efficacy on surgically curable biliary stone diseases.
The EST was performed with duodenoscope over the fluoroscopic table Forty one cases of EST were performed over the last 17 months. The range of age was 30 to 74(average 55.6). The EST was done preoperatively in 13, postoperatively in 16, and
without
surgery in 12 cases. Ten ESTs were done with laparoscopic cholecystectomies, 6 preoperatively, and 4 postoperatively. All 41 cases had common bile duct stones, 19 cases were combine with gallstones, 5 cases were combined with intrahepatic stones,
and 4
cases were combined with both gallstones and intrahepatic stones.
Thirty two of the ESTs were successful and eliminated further surgical procedures. In 9 unsuccessful cases, especially containing IHD stones, laparotomies were performed. There were seven complications with minor bleeding and pancreatitis which
recovered spontaneously. On 12 patients, EST was the only method of treatment, the results were satisfactory, but needs further follow up.
With the combination of surgery and EST we could achieve good results on biliary stone disease patients. The EST was a very successful and safe procedure in all ages. EST could eliminate unnecessary laparotomies and provide further comfort. If
there is
a competent endoscopist at the hospital, we must think of this as a supporting treatment modality for biliary stone dieases.
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