Endoscopic sphincterotomy of the papilla of Vater: an analysis of 300 cases.
Endoscopic sphincterotomy was performed on 300 patients with biliary and/or pancreatic disease during the period 1978-1983. The most frequent indications were choledocholithiasis after cholecystectomy (59%), choledocholithiasis without cholecystectomy (17%) and presumed motility disorders of the sphincter of Oddi (15%). In choledocholithiasis, stones passed spontaneously or were extracted from the bile duct in 147 of 164 patients (90%) in whom the outcome was determined by cholangiography immediately after stone extraction or by a second retrograde cholangiogram. In presumed motility disorders, only 51% of patients have shown sustained improvement in symptoms. Complications were uncommon (5%) but included bleeding from the margins of the incision, pancreatitis, cholangitis and an entrapped Dormia basket; no patient died. Duodenal diverticula were more frequent (p less than 0.005) in patients with bile duct stones after cholecystectomy (28%) than in patients in whom retrograde cholangiography did not reveal stones (9%) but the presence of diverticula did not influence the outcome of the procedure. Endoscopic sphincterotomy is a safe and effective procedure of particular relevance to elderly patients with choledocholithiasis after cholecystectomy and to high-risk patients with choledocholithiasis without cholecystectomy.
D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery*; D001657:Biliary Dyskinesia / Q000601:surgery*; D002763:Cholecystectomy / Q000009:adverse effects; D003138:Common Bile Duct Neoplasms / Q000601:surgery; D004240:Diverticulum / Q000150:complications; D004378:Duodenal Diseases / Q000150:complications; D004724:Endoscopy; D005260:Female; D042882:Gallstones / Q000150:complications / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery; D010195:Pancreatitis / Q000601:surgery