Endoscopic sphincterotomy for common bile duct stones: Impact of recent technical advances

Abstract

Technical improvements, such as mechanical lithotripsy, stenting or nasobiliary drainage, and wire-guided cannulation, have reduced the risk of complications in endoscopic sphincterotomy. To determine the extent of this reduction in risk, we assessed the medical records of 1352 patients with common bile duct stones in whom the procedure was conducted. Complications examined were: acute cholangitis and pancreatitis. Stone clearance was achieved in 1256 patients (92.8%), with an overall morbidity rate of 7.7% and a mortality rate of 0.15%. One hundred and forty-two patients had stones with a diameter greater than 20mm; 97 of these patients did not undergo lithotripsy. Cholangitis occurred in 10 of these 97 patients (10.3%), whereas, in the 45 patients who underwent lithotripsy, there were no cases of cholangitis (P = 0.02). Stone removal was not immediately accomplished or attempted in 396 patients. In 82 of these patients in whom a stent or a nasobiliary drain was placed in the common bile duct, the incidence of cholangitis was 1.2%, significantly less (P = 0.045) than the incidence of 6.4% in the other 314 patients given no stenting or nasobiliary drain. To overcome difficult cannulation, precut sphincterotomy was conducted in 134 patients and wireguided sphincterotomy, a recently introduced procedure, was conducted in 55 patients. When the precutting technique was used, the incidence of acute pancreatitis was significantly higher (8/134; 6.0%) than that in the patients in whom the standard procedure was conducted, i.e., neither the precut technique nor wire-guided ES was used (23/1218; 1.9%) (P = 0.008). There were no cases of pancreatitis in the 55 patients in whom wire-guided sphincterotomy was performed, although the difference was not statistically significant because of the small number of patients (P = 0.06). Based on these findings, we conclude that improved technologies have led to a significant reduction of complications in endoscopic sphincterotomy. Offprint requests to: M. Tanaka

Primary closure versus T-tube drainage in laparoscopic common bile duct exploration: a meta-analysis of randomized clinical trials

“…EST is effective and minimally invasive for removing bile duct stones and can be performed preoperatively, intraoperatively, or postoperatively. During the 1990s, the combination of preoperative EST and subsequent LC became a popular option for the treatment of choledocholithiasis [17,18]. Unfortunately, endoscopic retrograde cholangiopancreatography (ERCP)/EST has been associated with serious short-term complications, including bleeding, acute pancreatitis, and perforation of the digestive tract [19,20].…”

Invasive Techniken in der Inneren Medizin

“…Auch heute stellt diese Erkrankung die häufigste Indikation für die ERCP dar, können doch durch diesen Zugang zum Gallengang in ca. 80-90% aller Fälle die Steine mit Hilfe eines einfachen Dorminakorbs oder eines Ballons entfernt werden [1,2]. Wenn man zusätzliche moderne Hilfsmittel, wie die mechanische oder die Laserlithotripsie mit integriertem Steinerkennungssytem oder die ESWL, heranzieht erreicht die Erfolgsrate fast die 100% [3].…”

“…Vor 3 Jahren erschien im Deutschen Ärzteblatt der Beitrag "Glanz und Elend der Vortragskunst" vom Münchner Hautarzt Prof.Dr.med.M.Volkenandt, der für viel Aufsehen sorgte1 .Das große Interesse gegenüber diesem Beitrag äußerte sich in Leserbriefen, die durchweg positiv ausfielen.Der Autor, so schien es, traf "den Zahn der Zeit" und die Zusprache ermutigte ihn, das Thema auszuarbeiten und es in Buchform zu veröffentlichen. M.Volkenandt ist es gelungen, in kompakter Form, durch einen zum Teil witzigen zum Teil ernsthaften, aber stets engagierten Text und mit sehr passenden, einprägsamen Abbildungen einen praktischen Leitfaden für diejenigen zu verfassen, die Vorträge und Vorlesungen halten und bereit sind, ihre Kunst zu verbessern.…”

Problems Inherent to Balloon Dilation for the Treatment of Common Bile Duct Stones in Comparison With Endoscopic Sphincterotomy

“…[10][11][12] Among several complications associated with ES, acute cholangitis can be prevented by routine stent placement; 13,14 perforation can be avoided by slow and steady cutting with the use of a long-tipped sphincterotome; 15 and basket impaction can be avoided by the early use of mechanical lithotripters. [10][11][12] Among several complications associated with ES, acute cholangitis can be prevented by routine stent placement; 13,14 perforation can be avoided by slow and steady cutting with the use of a long-tipped sphincterotome; 15 and basket impaction can be avoided by the early use of mechanical lithotripters.…”

“…[10][11][12] Among several complications associated with ES, acute cholangitis can be prevented by routine stent placement; 13,14 perforation can be avoided by slow and steady cutting with the use of a long-tipped sphincterotome; 15 and basket impaction can be avoided by the early use of mechanical lithotripters. 12 Most of the complications associated with EPBD, however, relate to acute pancreatitis (Table 1). 12 Most of the complications associated with EPBD, however, relate to acute pancreatitis (Table 1).…”