Prospective Study
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World J Gastroenterol. Jul 7, 2014; 20(25): 8237-8243
Published online Jul 7, 2014. doi: 10.3748/wjg.v20.i25.8237
Comparative quality of life study between endoscopic sphincterotomy and surgical choledochotomy
Feng Liu, Xue Bai, Guang-Feng Duan, Wen-Hua Tian, Zhao-Shen Li, Bin Song
Feng Liu, Zhao-Shen Li, Bin Song, Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
Xue Bai, Guang-Feng Duan, Wen-Hua Tian, Department of Health Services Management, Second Military Medical University, Shanghai 200433, China
Author contributions: Liu F and Tian WH designed this study; Liu F collected the data for the choledocholithiasis cases; Bai X and Duan GF performed the literature review and the quality of life survey; Tian WH wrote and revised the manuscript; Li ZS and Song B coordinated and provided the case collection; Liu F, Bai X and Duan GF analyzed the data, wrote the manuscript and contributed equally to this study.
Correspondence to: Wen-Hua Tian, Professor, Department of Health Services Management, Second Military Medical University, No. 800 Xiangyin Road, Shanghai 200433, China. wh_tian@aliyun.com
Telephone: +86-21-81871428 Fax: +86-21-81871428
Received: December 30, 2013
Revised: March 30, 2014
Accepted: April 15, 2014
Published online: July 7, 2014
Abstract

AIM: To determine quality of life improvement in choledocholithiasis patients who underwent endoscopic sphincterotomy (EST) versus open choledochotomy (OCT).

METHODS: Eligible choledocholithiasis patients (n = 216) hospitalized in the Changhai Hospital between May 2010 and January 2011 were enrolled into a prospective study using cluster sampling. Patients underwent EST (n = 135) or OCT (n = 81) depending on the patient’s wishes. Patients were followed-up with a field survey and by correspondence. Patients were also given the self-administered Gastrointestinal Quality of Life Index (GIQLI) to measure patient quality of life before surgery, and at two and six weeks after the procedures.

RESULTS: With respect to baseline patient characteristics, the EST and OCT groups were comparable. After the procedure, gallstones were completely eliminated in all patients. Among 216 eligible patients, 191 patients (88.4%) completed all three surveys, including 118 patients who underwent EST (118/135; 87.4%) and 73 patients who underwent OCT (73/81; 90.1%). EST was associated with a significantly shorter hospital stay than OCT (8.8 ± 6.5 vs 13.9 ± 6.7 d; P < 0.001). The GIQLI score was similar between the EST and OCT groups before cholelithotomy (103.0 ± 15.4 vs 99.7 ± 10.2), but increased significantly in the EST group at two weeks (113.4 ± 12.0 vs 107.2 ± 11.2; P < 0.001) and six weeks (120.7 ± 10.6 vs 116.9 ± 7.5; P < 0.05) after the procedures.

CONCLUSION: EST, compared with OCT, is associated with better postoperative quality of life in patients treated for choledocholithiasis.

Keywords: Choledocholithiasis, Cholelithotomy, Endoscopic sphincterotomy, Open choledochotomy, Quality of life

Core tip: Endoscopic sphincterotomy (EST) is generally accepted as a safe and effective endoscopic modality in the treatment of choledocholithiasis. However, there are few reports evaluating whether EST contributes to better health-related quality of life improvement in patients undergoing cholelithotomy compared with open choledochotomy (OCT). The present study is the first report regarding the benefits of EST and OCT on gastrointestinal quality of life in a prospective comparative design. The current results show that EST, compared with OCT, is associated with better overall gastrointestinal quality of life in choledocholithiasis patients.