[Endoscopic sphincteroplasty (not sphincterotomy) using the clips--a preliminary report].
Reports exist that incomplete division of the papilla by endoscopic sphincterotomy may lead to restenosis, cholangitis, and stone recurrence. In view of evolution of surgical sphincterotomy to sphincteroplasty, we studied feasibility of endoscopic sphincteroplasty. In 36 dogs, at laparatomy, the papilla was divided using a diathermy sphincterotome to create retroperitoneal perforation. Twelve dogs underwent approximation of the bile duct and duodenal walls with silk sutures. Another 12 dogs had the walls approximated with clips using an endoscopic clip appliance. The other 12 dogs had no approximation. Blood chemistry was obtained before and serially after surgery. Duodenobiliary barium regurgitation was determined in 2-3 weeks. Four dogs each in each group were sacrificed at 1, 2, and 4 weeks to examine the papilla macro- and microscopically. In regard to hemostasis and prevention of leakage, the effect of the clips was similar to the sutures, resulting in a wide opening with free regurgitation. The no treatment group had persistent abnormal liver function tests and amylase levels. Three dogs died on leakage with abscess and the other nine had stenosis of the papilla. These data suggest that endoscopic sphincteroplasty may be feasible using the clips. A first clinical case where the clips were used to obtain a wide opening which passed a 15-mm balloon is briefly described.
Matsumoto
S
S
First Department of Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Ikeda
S
S
Tanaka
M
M
Yoshimoto
H
H
D014670:Ampulla of Vater / Q000473:pathology; D000818:Animals; D001774:Blood Chemical Analysis; D004285:Dogs; D004384:Duodenoscopy; D005240:Feasibility Studies; D013105:Sphincterotomy, Transduodenal / Q000379:methods*; D013537:Sutures