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Abstract
One hundred five patients with obstructive jaundice and cholangitis (49 patients),
referred for diagnostic endoscopy, were found to have inextractable bile duct stones.
Median age was 76 years and three quarters were more than 72 years of age. Insertion
of an endoprosthesis with or without a sphincterotomy relieved jaundice in 94% and
settled cholangitis in 90%. Antibiotic cover during the procedure seems essential
inasmuch as pyrexia and septicemia occurred in 6 of 57 cases where it was not given.
One case was lethal. Another patient died of acute pancreatitis. The patients were
old. One quarter died before the follow-up, 1to 5 years after the initial intervention.
The results indicate that the combination of endoscopic sphincterotomy, insertion
of an endoprosthesis, and, if feasible, stone extraction on a later occasion when
the acute phase of the illness had subsided brought the disease sufficiently under
control among three quarters of the patients with large common duct stones or stenoses
in the biliary tract. One quarter of the patients were treated surgically. This was
accomplished without mortality, but morbidity was not negligible. A policy with a
surgical approach restricted to selected cases with persistent symptoms in spite of
sufficient endoscopic drainage is recommended.
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Article info
Publication history
Accepted:
April 13,
1988
Identification
Copyright
© 1989 Published by Elsevier Inc.
