Long-term consequences of young patients undergoing endoscopic sphincterotomy: a cohort study

Abstract Background An estimated 15% of the UK population has gallstones. Gallstones in the biliary tree can result in complications such as cholangitis and pancreatitis, which have high morbidity and mortality rates. To prevent such complications, patients can undergo endoscopic sphincterotomy. In our centre, an initial study was undertaken in 2002 to examine outcomes of endoscopic sphincterotomy in patients under the age of 50 years. The aim of our current project was to examine the long-term outcomes until Nov 30, 2015. Methods Data from the study in 2002 were used to identify patients who had undergone endoscopic sphincterotomy between 1984 and 1992. The case notes for these patients were examined to identify outpatient hepatobiliary appointments, serial liver function tests, further investigations or procedures, and development of upper gastrointestinal malignancy or death. Data available included letters and scan reports. In the case of patient death, patients' general practitoners and the coroner's office were contacted. Findings 42 patients (32 women [76%]) had undergone endoscopic sphincterotomy between 1984 and 1992. At data collection in November, 2015, mean age was 55 years (SD 6·49), and mean follow-up since endoscopic sphincterotomy was 25 years (SD 2·40). Eight patients (19%) had died, two during the 2002 study, and six between 2002 and 2016. Two deaths were due to pancreatic adenocarcinoma at 8 months and 19 years after endoscopic sphincterotomy. One patient died from hepatocellular carcinoma; no other deaths were due to hepatobiliary or pancreatic disease or malignancy. Ten patients had no follow-up scans, imaging, or outpatient appointments. Of the 32 patients who had follow-up or investigations, two required further endoscopic sphincterotomy for recurrent stone disease at 22 and 25 years after their initial endoscopic sphincterotomy. Three patients had abnormal liver function tests but had no further investigations; three patients underwent further imaging but had no further interventions. Interpretation To our knowledge this is the first cohort study with such lengthy follow-up after endoscopic sphincterotomy. Our results suggest that endoscopic sphincterotomy is generally a safe and effective long-term treatment option that is not associated with major levels of recurrent disease or malignancy. This was a small single-centre cohort study and future population based studies should be conducted to better evaluate these findings in a larger cohort of patients. Funding None.