Endoscopic Sphincterotomy of the Ampulla of Vater

Abstract

A 44-year-old woman was admitted with severe epigastric pain and jaundice seven months after cholecystectomy. Retrograde cholangiography revealed a solitary floating stone in the common bile duct. Endoscopic electrosurgical papillotomy was successfully performed and the stone was extracted with a basket-tipped catheter. During a total of 11 papillotomies no complications were noted. Of these cases stones were completely removed in 7. Follow-up observations were negative in regard to stenosis, secondary inflammation of the bile ducts or reflux pancreatitis.

Percutaneous Transhepatic Removal of Bile Duct Stones: Results of 261 Patients

“…Since its introduction in 1974 by Kawai et al [16], endoscopic retrograde cholangiopancreatography with sphincterotomy has become the treatment of choice for bile duct stones, disorders of the sphincter of Oddi, including functional disorders, and stricture [8,[14][15][16][17][18]. However, it has complications rates of 5-19% with 1-3% mortality rates [8,17].…”

ERCP update: Diagnostic and therapeutic applications

“…After a complete evaluation of the patient utilizing all radiographic, radioisotopic, and ultrasonographic techniques, endoscopic evaluation is performed during ERCP to localize mucosal lesions not appreciated by other contrast studies increasing diagnostic yield. [11,12] was perfected as an alternative to surgical i n t e r v e n t i o n in high-risk patients with retained or recurrent gallstones a n d stenosis a n d has proven to be a safe n o n o p e r a t i v e technique specifically for this purpose. The m o r b i d i t y and mortality of the endoscopic group [28,29] are greatly reduced from that of surgical series [30], and the period of convalescence has been shortened to only a few days.…”

“…The ability to cannulate the papilla of Vater under direct vision to facilitate the opacification of the ductular structures of the biliary tract and pancreas has influenced our current approach to these problems by providing an expedient diagnosis and, thus, specific management. The capability of removing gallstones from the common bile duct and relieving stenosis of the duct has become a reality through endoscopic papillotomy (EP) [11,12], the newest application of ERCP.…”

Long-term symptoms following endoscopic sphincterotomy for common bile duct stones

“…Since the first description of endoscopic sphincterotomy (ES) by Classen and Demling [1] and Kawai et al [12] in 1974, the procedure has been widely used in the management of primary, retained, and recurrent bile duct stones. In particular, ES has proven popular in the management of biliary calculi in the elderly and other patients at high risk of developing complications after open surgery.…”