title: A comparative study of postendoscopic sphincterotomy complications with various types of electrosurgical current in patients with choledocholithiasis.
abstract: 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.
authors.affiliation: Department of Gastroenterology, Naval and Veterans Hospital, Athens, Greece.
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Stefanidis
authors.forename: George
authors.initials: G
authors.lastname: Karamanolis
authors.forename: Nikos
authors.initials: N
authors.lastname: Viazis
authors.forename: Spiros
authors.initials: S
authors.lastname: Sgouros
authors.forename: Efthimia
authors.initials: E
authors.lastname: Papadopoulou
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Ntatsakis
authors.forename: Apostolos
authors.initials: A
authors.lastname: Mantides
authors.forename: Helias
authors.initials: H
authors.lastname: Nastos
mesh_terms: 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
chemical_list: D008049:Lipase; D000681:Amylases