EVALUATION BY BILIARY SCINTIGRAPHY OF RECURRENCE OF CHOLEDOCHOLITHIASIS AFTER ENDOSCOPIC SPHINCTEROTOMY

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Abstract

Background

It is difficult to predict recurrence of choledocholithiasis after endoscopic sphincterotomy (EST). Because cholestasis is considered to cause recurrence of choledocholithiasis, it may be possible to predict recurrence by objective evaluation of cholestasis. The aim of the present study was to examine the relationship between cholestasis and recurrence of choledocholithiasis by biliary scintigraphy in post-EST cases.

Methods

Seventy-five patients who had undergone EST were tested by biliary scintigraphy. Cases with positive and negative detection of hot spots in the duodenum within 60 min after isotope infusion were categorized as ‘maintained bile excretion’ (Group M) and ‘delayed bile excretion’ (Group D), respectively. Age, gender, biliary tract enzyme levels, diameter of the common bile duct, presence of the gallbladder, presence of juxtapapillary duodenal diverticula, and the recurrence rates of choledocholithiasis were compared between the two groups.

Results

Seventy-five cases were distributed into 66 cases (88%) in Group M and nine cases (12%) in Group D. There was no statistical differences in age, gender, biliary tract enzyme levels, diameter of the common bile duct, and presence of juxtapapillary diverticula. In Group D, all the cases had retained the gallbladder. Of 41 cases who had been followed up for more than 1 year, 35 cases (85%) were assigned to Group M and six (15%) to Group D. Recurrence of choledocholithiasis was observed in five cases, with two in Group M and three in Group D. The recurrence rate was significantly higher in Group D than in Group M.

Conclusions

Biliary scintigraphy was considered useful for objectively predicting recurrence of choledocholithiasis.

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