Johnston S D, Lim P, Collins J S A, Watson R G P, Tham T C K
Division of Gastroenterology, Ulster Hospital, Belfast, Northern Ireland.
Ir J Med Sci. 2002 Oct-Dec;171(4):197-8. doi: 10.1007/BF03170279.
Endoscopic sphincterotomy (ES) is indicated in patients with confirmed bile duct stones at endoscopic retrograde cholangiopancreatography (ERCP). The role of ES in patients with suspected bile duct stones but a normal cholangiogram, in the prevention of recurrent biliary symptoms, when cholecystectomy is not planned, is unclear.
To determine if prophylactic ES prevents further biliary problems in such patients.
Patients were identified with gallbladder stones presenting with jaundice, abnormal liver function tests (LFTs) or dilated bile ducts on ultrasound, in whom cholecystectomy was not planned and who had a normal cholangiogram at ERCP. Patients were followed-up to determine the frequency of recurrent biliary problems or repeat investigations.
Forty-one patients were included, of whom 20 had an ES. The frequency of pre-ERCP features did not differ between the two groups. Median follow-up was 32 months (range 15-66). Post-ERCP recurrent abdominal pain (5 vs 3; p=0.39), jaundice (3 vs 1; p=0.28), pancreatitis (0 vs 1; p=0.32), and repeat ultrasound (2 vs 1; p=0.52), ERCP (1 vs 1; p=0.97) or cholecystectomy (2 vs 3, p=0.82) did not differ between the two groups.
Patients with gallstones, suspected common bile duct (CBD) stones and a normal cholangiogram need not have a prophylactic sphincterotomy since there is no reduction in recurrent biliary problems and this potentially increases the morbidity.
内镜下括约肌切开术（ES）适用于经内镜逆行胰胆管造影（ERCP）确诊为胆管结石的患者。对于怀疑有胆管结石但胆管造影正常的患者，在不计划行胆囊切除术时，ES在预防复发性胆道症状方面的作用尚不清楚。
确定预防性ES是否能预防此类患者出现进一步的胆道问题。
纳入有胆囊结石且伴有黄疸、肝功能检查异常（LFTs）或超声显示胆管扩张的患者，这些患者不计划行胆囊切除术且ERCP胆管造影正常。对患者进行随访，以确定复发性胆道问题或重复检查的频率。
共纳入41例患者，其中20例行ES。两组患者ERCP术前特征的频率无差异。中位随访时间为32个月（范围15 - 66个月）。两组患者ERCP术后复发性腹痛（5例对3例；p = 0.39）、黄疸（3例对1例；p = 0.28）、胰腺炎（0例对1例；p = 0.32）以及重复超声检查（2例对1例；p = 0.52）、ERCP（1例对1例；p = 0.97）或胆囊切除术（2例对3例，p = 0.82）均无差异。
有胆结石、怀疑胆总管（CBD）结石且胆管造影正常的患者无需进行预防性括约肌切开术，因为复发性胆道问题并未减少，且这可能会增加发病率。
