• Yousuke Nakai, Hiroyuki Isayama, Takeshi Tsujino, Tsuyoshi Hamada, Hirofumi Kogure, Naminatsu Takahara, Dai Mohri, Saburo Matsubara, Natsuyo Yamamoto, Minoru Tada, and Kazuhiko Koike.
• Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan.
• Surg Endosc. 2016 Jul 1; 30 (7): 3014-20.

BackgroundCholecystectomy after endoscopic sphincterotomy for bile duct stones with concomitant gallstones is known to reduce late biliary complications. Endoscopic papillary balloon dilation for bile duct stones develops fewer late biliary complications than endoscopic sphincterotomy, but no randomized controlled trials have been conducted about the role of cholecystectomy after endoscopic papillary balloon dilation. Therefore, we conducted this propensity score-matched analysis to compare cholecystectomy and wait-and-see approach after endoscopic papillary balloon dilation.MethodsPropensity score matching extracted 147 pairs of patients with cholecystectomy after endoscopic papillary balloon dilation and with gallbladder left in situ with stones (wait-and-see) from 725 patients who underwent endoscopic papillary balloon dilation for bile duct stones. Late biliary complications such as recurrent bile duct stones and cholecystitis were evaluated. Cumulative incidence of late biliary complications was calculated treating death without biliary complications as a competing risk, and its prognostic factor was evaluated.ResultsThe rates of late biliary complications were 5.4 and 25.2 % in the cholecystectomy after endoscopic papillary balloon dilation and wait-and-see groups: Recurrent bile duct stones rates were 4.1 and 19.0 %, and cholecystitis rates were 0.7 and 6.1 %. The cumulative incidences of biliary complications in the cholecystectomy after endoscopic papillary balloon dilation and wait-and-see approach were 3.1 versus 13.0 % at 1 year and 5.7 versus 28.0 % at 5 year after endoscopic papillary balloon dilation (p = 0.008). Subdistribution hazard ratio of late biliary complications in the wait-and-see group was 5.1 (p = 0.020).ConclusionCholecystectomy after endoscopic papillary balloon dilation for choledocholithiasis was associated with fewer late biliary complications. Prophylactic cholecystectomy should be offered to all surgically fit patients after endoscopic papillary balloon dilation for bile duct stones with concomitant gallstones.

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