Spontaneous Passage of GallbladderCalculi-Facilitation by Endoscopic Sphincterotomy

摘要

After Endoscopic sphincterotopy (ES) gallbladdermotility increases leading to expulsion of crystalsand stones. But this is not a universal phenomenon.We evaluated cholangiographic findings in patientsemptying their gallbladder after ES for commonbile duct (CBD) stones. Cholangiographic featuresof twenty patients expelling gallbladder calculiafter ES were studied. Controls included 20 age andsex matched patients with gallstones and CBDstones, who did not expel gallstones after ES. Of 20cases in study group, 9 recovered more than 20stones each in the stool within 7 days of ES. RepeatERCP showed empty gallbladder in all, whereasCBD was full of stones in 11 of the 20 cases. In thestudy group, low insertion of the cystic duct wasmore common (10 vs 0,p<0.04), the cystic ductmade a narrow angle (20±5° vs 50±10°,p<0.04)with CBD before insertion and cystic duct diameterwas higher (5 mm vs 2.5 mm,p<0.04) as comparedto controls. We conclude that in patients undergoingES with intact gallbladder and small gallbladdercalculi, spontaneous emptying ofgallbladder calculi occurs, if cystic duct is wider,has low insertion and makes narrow angle withCBD before insertion.