Duodenoscopic Sphincterotomy and Gallstone Removal

Non-operative removal of bile duct stones by duodenoscopic sphincterotomy

“…In this series of 134 patients the success rate for achieving sphincterotomy was 96 per cent, and for removing duct stones 92.5 per cent (of successful sphincterotomies), Important complications occurred in 10 patients, 1 of whom died. These results mirror those of earlier reports (6)(7)(8)(9) and of a recent large survey (10) in which the overall success rate for stone removal was 90.5 per cent with a mortality of 1.4 per cent. In addition to the complications recorded in this series (bleeding, stone impaction, cholangitis), other authors (10, 1 1) have reported retroperitoneal perforation and acute pancreatitis.…”

The Non‐operative Management of Gallstones

“…(2) Access via the duodenum .-The development of endoscopic retrograde cannulation of the common bile duct via the papilla of Vater has been the basts of endoscopic papillotomy. This technique has been used tn part1cular by Classen and Demling (1974) of West Germany, and by Kawai et al11 (1973) of Japan, wtlh considerable success, but has been slow to develop in Australia and New Zealand Although the pnme ind1catton is retained common b1le duct stones, endoscopic papillotomy may also be useful as an alternative to cholecystectomy and exploration in poor-nsk patients with bile duct obstruclton (Safrany, 1977) . As this is a new technique, long-term complications are not known Early complications of this Procedure have been descnbed (Classen and Ossenberg , 1977) , and i nclude bleeding , pertorat1on , cholangitis , and pancreatitis, but the mortality has been low at approximately 1%.…”

Pain after cholecystectomy

“…In Australia this has been brought home by the recent report of a young Victorian man who shot his quadriplegic friend and then himself. 5 There is no doubt that society's attitudes towards suicide have changed markedly in recent years, and this has been reflected in the decriminalization of suicide in many countries. Recently, changes in personal attitudes have been elegantlydemonstrated in Holland over a period as brief as five years, during which time heated public debate on the acceptability of suicide and euthanasia has occurred.· The instrument of change has undoubtedly been the media (both electronic and printed) and persuasive evidence now exists of its power to influence suicidal behaviour.…”

“…The possibility that symptoms of this type are due to impaired drainage of bile through the sphincter of Oddi has been suspected for several years and has led to the application of techniques designed to decompress the biliary system, including choledochoduodenostomy,: operative sphincteroplasty' and endoscopic sphincterotomy. 5 These procedures may be helpful in some patients, but in others symptoms continue in spite of satisfactory decompression, as assessed by an adequate stomal opening on duodenal endoscopy; the presence of air in the biliary system; and the rapid passage of radiological contrast medium from the biliary system after retrograde cholangiography. At surgery, some patients have apparent narrowing within the sphincter, ' while others may have histological changes in sphincter tissue including fibrosis, muscle hypertrophy, mucosal changes and evidence of inflammation.…”