What is involved in endoscopic sphincterotomy for gallstones?

Mj, Slooff; Baker, Russell T.; Lavelle, M.I.; Lendrum, R; Venables, C W

doi:10.1002/bjs.1800670106

Cited by 9 publications

(1 citation statement)

References 21 publications

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“…The precutting technique, used to overcome the difficulty of entering the CBD, was associated with a 6% incidence of acute pancreatitis postoperatively, whereas this incidence was only 1.9% in patients who did not require precutting. The greater risk of pancreatitis in patients who undergo precutting has also been noted in other reports . The use of a guide wire to enter the CBD, as an alternative to precutting, has been reported previously 14.…”

Section: Discussionsupporting

confidence: 55%

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

Tanaka

Konomi

Matsubara

et al. 1997

J Hep Bil Pancr Surg

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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

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Section: Discussionsupporting

confidence: 55%

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

Tanaka

Konomi

Matsubara

et al. 1997

J Hep Bil Pancr Surg

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Dissolution of common bile duct stones

Motson

1981

British Journal of Surgery

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Retained common duct stones can now be treated by a number of non-operative techniques, including dissolution by cholesterol solvents, simple irrigation, stone extraction via the T tube tract and by endoscopic sphincterotomy. This paper reviews the various solvents available for stone dissolution and its physicochemical basis. When a retained stone is found simple irrigation with saline will be successful in about 50 per cent of patients. If this fails, stone extraction via the T tube tract or by endoscopic sphincterotomy are now the methods of choice, with a 90--95 per cent chance of success. Stone dissolution by cholic acid is slow and is only successful in about 60 per cent of patients but can be of value when stone extraction is unavailable or unsuccessful.

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Successes, failures, early complications and their management following endoscopic sphincterotomy: Results in 394 consecutive patients from a single centre

Leese

Neoptolemos

Carr‐Locke

1985

British Journal of Surgery

207

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The indications and results of 394 endoscopic sphincterotomies (ES) performed over a 6 year period from a single centre are described. The indications for ES were common bile duct (CBD) calculi (81 per cent), papillary stenosis (9 per cent), periampullary tumours, insertion of endoprostheses, sump syndrome and biliary dilatation for benign strictures. ES was achieved in 98 per cent of patients. In the calculus group the CBD was cleared of stones in 93.3 per cent following a successful ES (92 per cent overall success rate for CBD clearance). Early complications (less than or equal to 1 month) occurred in 41 patients (10.4 per cent) of which haemorrhage accounted for nearly half. Emergency surgery following ES was undertaken in 15 patients (3.8 per cent). There were 13 deaths within one month of ES (3.3 per cent) of which three were directly attributable to ES (0.8 per cent). The diagnosis and management of complications following ES is important with increasing numbers of patients being treated from outside the referral centre.

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What is involved in endoscopic sphincterotomy for gallstones?

Cited by 9 publications

References 21 publications

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

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

Dissolution of common bile duct stones

Successes, failures, early complications and their management following endoscopic sphincterotomy: Results in 394 consecutive patients from a single centre

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