The outlook for patients with symptomatic cholelithiasis managed by cholecystectomy is favourable. The same holds for patients with choledocholithiasis who undergo endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy and stone extraction, followed later by cholecystectomy.
Recurrent choledochal problems
Recurrent bile duct stones occur in 5% to 20% of patients after endoscopic sphincterotomy.[1]European Association for the Study of the Liver (EASL). EASL clinical practice guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 2016 Jul;65(1):146-81.
https://www.journal-of-hepatology.eu/article/S0168-8278(16)30032-0/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/27085810?tool=bestpractice.com
Risk factors for recurrent choledochal problems include: pre-existing patient factors (e.g., bile composition and biliary anatomy); factors related to the sphincterotomy (sphincter ablation and papillary stenosis); bile duct dilatation to >13 mm; multiple common bile duct stones; and brown pigment stones.[97]Narula VK, Fung EC, Overby DW, et al. Clinical spotlight review for the management of choledocholithiasis. Surg Endosc. 2020 Apr;34(4):1482-91.
https://www.sages.org/publications/guidelines/clinical-spotlight-review-management-of-choledocholithiasis
http://www.ncbi.nlm.nih.gov/pubmed/32095952?tool=bestpractice.com
[117]Costamagna G, Tringali A, Shah SK. Long-term follow-up of patients after endoscopic sphincterotomy for choledocholithiasis and risk factors for recurrence. Endoscopy. 2002 Apr;34(4):273-9.
http://www.ncbi.nlm.nih.gov/pubmed/11932781?tool=bestpractice.com
[118]Sugiyama M, Atomi Y. Risk factors predictive of late complications after endoscopic sphincterotomy for bile duct stones: long-term (more than 10 years) follow-up study. Am J Gastroenterol. 2002 Nov;97(11):2763-7.
http://www.ncbi.nlm.nih.gov/pubmed/12425545?tool=bestpractice.com
[119]Sugiyama M, Suzuki Y, Abe N, et al. Endoscopic retreatment of recurrent choledocholithiasis after sphincterotomy. Gut. 2004 Dec;53(12):1856-9.
https://gut.bmj.com/content/53/12/1856.long
http://www.ncbi.nlm.nih.gov/pubmed/15542528?tool=bestpractice.com