endoscopic sphincterotomy

Haemorrhage after endoscopic sphincterotomy occurs in 2.5-4% of cases.

Endoscopic sphincterotomy was performed in 16 patients with successful removal of all calculi in seven.

Endoscopic sphincterotomy (both of the biliary and the pancreatic sphincters)

Endoscopic sphincterotomy is now the primary treatment for bile duct stones in most clinical contexts, whether emergency or elective.

Patient XII was managed by an endoscopic sphincterotomy after percutaneous drainage of the collection.

Briefly, after diagnostic ERCP, endoscopic sphincterotomy is carried out with a long nose sphincterotome.

Endoscopic sphincterotomy and basket extraction of the stones has been the most widely used technique having an overall success rate of 85% in clearing the ducts.

Two of three jaundiced patients underwent endoscopic sphincterotomy to remove duct stones after successful percutaneous cholecystolithotomy and the stone passed spontaneously in the third.

In one patient in whom there appeared to be delay in biliary drainage at endoscopic retrograde cholangiopancreatography (>30 minutes), an endoscopic sphincterotomy was performed.

After five days, an ERCP elsewhere showed bile leakage from the cystic duct stump and a small endoscopic sphincterotomy was performed, followed by stent insertion.

The treatment of bile leakage after open cholecystectomy, by endoscopic sphincterotomy or stent placement has been reported to yield acceptable results, especially when the patient is referred in an early phase.

La Farla et al, found that endoscopic sphincterotomy significantly increased the incidence of pancreatitis after ERCP, however, none of the patients who underwent sphincterotomy in our study developed pancreatitis.

One patient had a combined cholecystoscopy and endoscopic sphincterotomy to clear stones from the gall bladder and bile duct, leaving two patients with a failed clearance, one of whom is without symptoms (patient IV).

In essence our policy is as follows (Table II): when bile duct leakage is present, we prefer to decompress the biliary tree through endoscopic sphincterotomy, often followed by shortterm (4-6 weeks) insertion of a biliary endoprosthesis.

Only six of the 13 patients had a clear gall bladder at the end of the first procedure, but after further treatments that included cholecystoscopy, endoscopic sphincterotomy, and percutaneous cholecystolithotomy 11 patients had a gall bladder free of stones.

In a study of 54 patients undergoing endoscopic sphincterotomy, the continuous infusion of cyclic somatostatin in a dose of 250 g/hour over 26 hours beginning two hours before ERCP did not significantly reduce pancreatic enzyme rise compared with placebo.

The experience reported suggests that the method is effective in that at the end of the rotary lithotrite procedures 17 patients had a gall bladder clear of stones, and with subsequent proceduressuch as cholecystoscopy, endoscopic sphincterotomy, and percutaneous cholecystolithotomy all but two patients had stones cleared from the biliary system.