A comparative study of postendoscopic sphincterotomy complications with various types of electrosurgical current in patients with choledocholithiasis.
BACKGROUND
Whether the type of electrosurgical current used for endoscopic sphincterotomy influences the frequency of postsphincterotomy complications is unknown.


METHODS
One hundred eighty-six patients with choledocholithiasis were prospectively randomized to undergo endoscopic sphincterotomy with pure cutting current (n = 62, Group A), blended current (n = 62, Group B), or pure cutting initially followed by blended current (n = 62, Group C). Serum concentrations of amylase and lipase were evaluated in all patients 12 and 24 hours after sphincterotomy. Clinical pancreatitis was classified as mild, moderate, or severe. Postsphincterotomy bleeding was defined as a decrease in hematocrit of greater than 5%.


RESULTS
Serum concentrations of amylase and lipase were greater in Groups B and C at 12 and 24 hours after the procedure, as compared with Group A. Clinical mild pancreatitis occurred in 2 patients in Group A (3.2%), 8 in Group B (12.9%), and in 8 in Group C (12.9%). The differences were statistically significant for Group A compared with either Group B or Group C (p = 0.048). Postsphincterotomy bleeding occurred in 3 patients (1.6%), one in each group.


CONCLUSIONS
The use of pure cutting electrosurgical current during endoscopic sphincterotomy in patients with choledocholithiasis is associated with a lesser degree of pancreatic enzyme elevation and lower frequency of pancreatitis, whereas bleeding is not increased compared with blended current. Changing from pure cutting to blended current after the first 3 to 5 mm of the incision is associated with an increased rate of complications compared to the use of pure cutting current for the entire sphincterotomy.
Stefanidis
Gerasimos
G
Department of Gastroenterology, Naval and Veterans Hospital, Athens, Greece.
Karamanolis
George
G
Viazis
Nikos
N
Sgouros
Spiros
S
Papadopoulou
Efthimia
E
Ntatsakis
Konstantinos
K
Mantides
Apostolos
A
Nastos
Helias
H
D000328:Adult; D000368:Aged; D000681:Amylases / Q000032:analysis; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods; D004598:Electrosurgery / Q000295:instrumentation*; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008049:Lipase / Q000032:analysis; D008297:Male; D008875:Middle Aged; D010186:Pancreatic Function Tests; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome
D008049:Lipase; D000681:Amylases