• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of annsurgLink to Publisher's site
Ann Surg. Jun 1991; 213(6): 627–634.
PMCID: PMC1358591

Choledocholithiasis. Endoscopic sphincterotomy or common bile duct exploration.


A prospective randomized trial was conducted of preoperative endoscopic sphincterotomy and surgery (ES&S) or surgery alone (SA) in 52 patients with cholecystolithiasis and choledocholithiasis that were candidates for elective surgery. After ES&S 65% of patients were stone free. Eighty-eight per cent of patients with SA were stone free after surgery (p less than 0.05). Three patients in each group had residual stones at the completion of the operation. Five of these six had more than 20 common bile duct (CBD) stones. There was one episode of major hemorrhage in a patient in each group and no deaths. Costs were essentially equal for the individual patient with a successful ES as compared to SA. Societal costs of a program of preoperative endoscopic retrograde cholangiopancreatography and ES would be higher because of the cost of screening for patients with CBD stones. These results do not support preoperative ES as a technique for clearance of the CBD of stones on the basis of efficacy, morbidity rate, or cost.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.6M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Images in this article

Click on the image to see a larger version.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Traverso LW. Carl Langenbuch and the first cholecystectomy. Am J Surg. 1976 Jul;132(1):81–82. [PubMed]
  • Tompkins RK. Laparoscopic cholecystectomy. Threat or opportunity? Arch Surg. 1990 Oct;125(10):1245–1245. [PubMed]
  • Brendel W, Enders G. Shock waves for gallstones: animal studies. Lancet. 1983 May 7;1(8332):1054–1054. [PubMed]
  • Zimmon DS. Alternatives to cholecystectomy and common duct exploration. Am J Gastroenterol. 1988 Nov;83(11):1272–1273. [PubMed]
  • Thistle JL, May GR, Bender CE, Williams HJ, LeRoy AJ, Nelson PE, Peine CJ, Petersen BT, McCullough JE. Dissolution of cholesterol gallbladder stones by methyl tert-butyl ether administered by percutaneous transhepatic catheter. N Engl J Med. 1989 Mar 9;320(10):633–639. [PubMed]
  • Murray WR, LaFerla G, Fullarton GM. Choledocholithiasis--in vivo stone dissolution using methyl tertiary butyl ether (MTBE). Gut. 1988 Feb;29(2):143–145. [PMC free article] [PubMed]
  • Koch H, Rösch W, Walz V. Endoscopic lithotripsy in the common bile duct. Gastrointest Endosc. 1980 Feb;26(1):16–18. [PubMed]
  • Classen M, Demling L. Endoskopische Sphinkterotomie der Papilla Vateri und Steinextraktion aus dem Ductus choledochus. Dtsch Med Wochenschr. 1974 Mar 15;99(11):496–497. [PubMed]
  • Kawai K, Akasaka Y, Murakami K, Tada M, Koli Y. Endoscopic sphincterotomy of the ampulla of Vater. Gastrointest Endosc. 1974 May;20(4):148–151. [PubMed]
  • Cotton PB, Vallon AG. British experience with duodenoscopic sphincterotomy for removal of bile duct stones. Br J Surg. 1981 Jun;68(6):373–375. [PubMed]
  • Sivak MV., Jr Endoscopic management of bile duct stones. Am J Surg. 1989 Sep;158(3):228–240. [PubMed]
  • Davidson BR, Neoptolemos JP, Carr-Locke DL. Endoscopic sphincterotomy for common bile duct calculi in patients with gall bladder in situ considered unfit for surgery. Gut. 1988 Jan;29(1):114–120. [PMC free article] [PubMed]
  • Leese T, Neoptolemos JP, Baker AR, Carr-Locke DL. Management of acute cholangitis and the impact of endoscopic sphincterotomy. Br J Surg. 1986 Dec;73(12):988–992. [PubMed]
  • Neoptolemos JP, Carr-Locke DL, London NJ, Bailey IA, James D, Fossard DP. Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones. Lancet. 1988 Oct 29;2(8618):979–983. [PubMed]
  • Martin DF, Tweedle DE. Endoscopic management of common duct stones without cholecystectomy. Br J Surg. 1987 Mar;74(3):209–211. [PubMed]
  • Worthley CS, Toouli J. Gallbladder non-filling: an indication for cholecystectomy after endoscopic sphincterotomy. Br J Surg. 1988 Aug;75(8):796–798. [PubMed]
  • Leow CK, Thompson MH. Endoscopic papillotomy without cholecystectomy for bile duct stones. Ann R Coll Surg Engl. 1986 Nov;68(6):310–311. [PMC free article] [PubMed]
  • Escourrou J, Cordova JA, Lazorthes F, Frexinos J, Ribet A. Early and late complications after endoscopic sphincterotomy for biliary lithiasis with and without the gall bladder 'in situ'. Gut. 1984 Jun;25(6):598–602. [PMC free article] [PubMed]
  • Neoptolemos JP, Davidson BR, Shaw DE, Lloyd D, Carr-Locke DL, Fossard DP. Study of common bile duct exploration and endoscopic sphincterotomy in a consecutive series of 438 patients. Br J Surg. 1987 Oct;74(10):916–921. [PubMed]
  • Miller BM, Kozarek RA, Ryan JA, Jr, Ball TJ, Traverso LW. Surgical versus endoscopic management of common bile duct stones. Ann Surg. 1988 Feb;207(2):135–141. [PMC free article] [PubMed]
  • Neoptolemos JP, Carr-Locke DL, Fossard DP. Prospective randomised study of preoperative endoscopic sphincterotomy versus surgery alone for common bile duct stones. Br Med J (Clin Res Ed) 1987 Feb 21;294(6570):470–474. [PMC free article] [PubMed]
  • Cotton PB. Endoscopic management of bile duct stones; (apples and oranges). Gut. 1984 Jun;25(6):587–597. [PMC free article] [PubMed]
  • Way LW, Admirand WH, Dunphy JE. Management of choledocholithiasis. Ann Surg. 1972 Sep;176(3):347–359. [PMC free article] [PubMed]
  • Feliciano DV, Mattox KL, Jordan GL., Jr The value of choledochoscopy in exploration of the common bile duct. Ann Surg. 1980 May;191(5):649–654. [PMC free article] [PubMed]
  • Glenn F. Retained calculi within the biliary ductal system. Ann Surg. 1974 May;179(5):528–539. [PMC free article] [PubMed]
  • Burhenne HJ. Complications of nonoperative extraction of retained common duct stones. Am J Surg. 1976 Mar;131(3):260–262. [PubMed]
  • Pappas TN, Slimane TB, Brooks DC. 100 consecutive common duct explorations without mortality. Ann Surg. 1990 Mar;211(3):260–262. [PMC free article] [PubMed]
  • McSherry CK, Glenn F. The incidence and causes of death following surgery for nonmalignant biliary tract disease. Ann Surg. 1980 Mar;191(3):271–275. [PMC free article] [PubMed]
  • Van Stiegmann G, Pearlman NW, Goff JS, Sun JH, Norton LW. Endoscopic cholangiography and stone removal prior to cholecystectomy. A more cost-effective approach than operative duct exploration? Arch Surg. 1989 Jul;124(7):787–790. [PubMed]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...