The Effectiveness of a Preoperative Endoscopic Sphincterotomy before the Laparoscopic Cholecystectomy / 대한소화기내시경학회지

BACKGROUND/AIMS: There are some options which exist in the optimal treatment of Common Bile Duct (CBD) stones. The management of CBD stones by a preoperative Endoscopic Sphincterotomy (EST) and a Laparoscopic Cholecystectomy (LC) remains controveraial. This study intends to investigate the value of an EST before an LC in patients with CBD stones compared with a conventional Open Cholecystectomy (OC) with a Common Bile Duct Exploration (CBDE). METHODS: Sixty three patients underwent an EST before an LC, while 65 patients received an OC with a CBDE were reviewed retrospectively for a 42 month period from January, 1993 to June, 1996. RESULTS: There was no statistical significance of stone numbers and sizes in both groups (p>0.05), but the EST before the LC group a showed a shorter hospital stay (12.2 days:19.8 days, p 0.05). Rate of stone recurrence and remnant stones in the OC with CBDE group (50.8%) was ater than the EST before LC group (25.4%)(p <0.05). The total hospitalization fee in the EST before LC group was lesser than the OC with CBDE group (p<0.05). CONCLUSIONS: An EST before an LC is a valuable option for patients with gall stones and simultaneous choledocholithiasis and is suitable according to recent trends in the minimal invasive approach. It needs however, larger group evaluation in order to determine the accurate indications and proper patient selection for this procedure.

Effectiveness of Early Endoscopic Procedures on the Diagnosis and Treatment of the Gallstone Pancreatitis / 대한소화기내시경학회지

BACKGROUND/AIMS: Gallstone pancreatitis has showed higher mortality and morbidity rate as compared to other causes of pancreatitis, and the proper timing of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) is still controversial. But recent several trials reveals early ERCP/EST is safe procedure and can reduce mortality and complication rate in gallstone pancreatitis. METHODS: To assess the safety and effectiveness of early ERCP/EST, we perfomed ERCP and EST, if necessary, in 40 cases of acute gallstone pancreatitis. RESULTS: 1) Early ERCP group (in 72 hours) were 27 cases, delayed group were 13 cases, and 11 early EST group, 16 delayed EST group. No statistically significant difference was found between two groups in blood chemistry and the severity of pancreatitis according to Ranson's criteria, respectively. No remarkable complication due to ERCP or EST was noted, and the hospital days were shorter in early ERCP/EST group with statistical significance, 2) Duodenoscopic findings show 14 normal papillae, 20 papillary edema, hemorrhagic and lacerated papillae in 6 cases. CONCLUSION: In cases of gallstone pancreatitis, early ERCP and EST is considered as a safe and effective treatment modality.