Comprehensive Investigation of Long-Term Outcomes of Transpapillary Interventions in Patients With Choledocholithiasis

BACKGROUND: The diagnosis of the long-term outcomes of endoscopic treatment for choledocholithiasis is understudied, resulting in dissatisfaction in both patients and surgeons.

AIM: To study the diagnostic capabilities of various integrated methods for the long-term assessment of the major duodenal papilla and bile duct function after different transpapillary interventions for choledocholithiasis.

METHODS: Sixty-seven patients with choledocholithiasis aged 19 to 83 years (mean age 61.3 ± 5.7 years) underwent hepatobiliary scintigraphy, endosonography, and duodenoscopy 12 to 36 months after transpapillary interventions. Patients were divided into two groups. Group 1 (n = 36) received sphincter-preserving treatment, and group 2 (n = 31) received non–sphincter-preserving treatment. We assessed the diameter of the choledochus, wall thickness, and presence of gallstones in the common bile duct. We used nonparametric Mann–Whitney tests to conduct a statistical analysis of the between-group differences. We analyzed the parameter relationships using nonparametric correlation analysis and the calculation of gamma rank correlation coefficients.

RESULTS: Long-term duodenoscopy after transpapillary interventions allows us to estimate the preservation coefficient of the intramural choledochus, that is, the degree of sphincter of Oddi dissection of less than 30% and greater than 70%. When this parameter exhibited a low value, the following conditions were detected significantly more often by endosonography: increased diameter of choledochus ≥ 7 mm (p = 0.007; the reference value is ≤6 mm), wall thickening of the common bile duct > 1 mm (p < 0.001), aerobilia and transient dilatation of the choledochus with water load (p = 0.001 and p = 0.01, respectively), and a gallstone in the common bile duct (p = 0.002). Correlation analysis showed a meaningful (p < 0.05) relationship between radiopharmaceutical agent transit time > 20 minutes and the dysfunction index (γ = 0.750 for dysfunction index > 1; γ = −0.785 for dysfunction index ≤ 1), which indicates the risk of decompensation of barrier function and possible complications with persistently slow transit.

CONCLUSION: The integrated approach using hepatobiliary scintigraphy, endosonography, and duodenoscopy is an unbiased assessment method of the major duodenal papilla and bile duct function after transpapillary interventions for choledocholithiasis.