Endoscopic Sphincterotomy for Common Bile Duct Calculi

Abstract

A series of 74 patients having endoscopic sphincterotomy for common bile duct calculi is reported. Complete stone extraction was achieved in 53 cases (72%). Seventeen of 21 patients with retained calculi following recent biliary surgery had successful extractions (80%). Of 30 patients having had a cholecystectomy, 21 (70%) were successful, but only 15 of 23 patients with obstructive jaundice and no previous biliary surgery had the ducts cleared of calculi. Failure was due to multiple stones in the duct, or calculi too large to pass through the sphincterotomy. Endoscopic sphincterotomy is advocated in patients with obstructive jaundice due to stones, moving to early surgery should it prove unsuccessful. The results in patients with a T‐tube in situ are comparable to extraction of the calculi along the T‐tube tract.

Relation of size and number of common duct calculi to success of sphincterotomy and stone extraction

“…This result is comparable with that reported by Askew et al [1] with 72%, Classen [2] with 85%, Kullman et al [3] with 91%, and Leese et al [4] with 91%.…”

“…Stone size was of importance to attain complete clearance of CBDC as larger stones (> 1 cm) were significantly more difficult to extract endoscopically than smaller stones (p<0.01). A comparison between patients with one CBDC and those with two or more show a statistically significant difference in that the former group is easier to treat successfully (p<0.001).Key words: Common bile duct calculi -Endoscopic sphincterotomy -Stone extraction, technique.Endoscopic sphincterotomy (ES) is being used with an increasing frequency for treatment of common duct calculi [1][2][3][4]. Empirical observations indicate that this technique is most successful in patients with small biliary calculi lodged in the distal common bile duct.…”

“…Endoscopic sphincterotomy (ES) is being used with an increasing frequency for treatment of common duct calculi [1][2][3][4]. Empirical observations indicate that this technique is most successful in patients with small biliary calculi lodged in the distal common bile duct.…”