Endoscopic sphincterotomy in the treatment of cholangiopancreatic diseases.
OBJECTIVE
To investigate the therapeutic effect of endoscopic sphincterotomy (EST) in the treatment of choledocholithiasis and stenosing papillitis.


METHODS
A total of 1 026 patients undergoing EST during July 1983 to May 2003 at the institute were retrospectively analyzed. Chronic pancreatitis was diagnosed in 63 (6.1%), cholecystolithiasis and choledocholithiasis in 549 (53.5%), stones in residual biliary duct in 249 (24.3%), stenosing papillitis in 228 (22.2%). In patients with simple stenosing papillitis, most incisions were within 0.5-1 cm in length. As for patients with chronic pancreatitis simultaneously, selective pancreatic sphincterotomy was performed, and incision was within 0.5-0.8 cm in length. For stones less than 1 cm, incision was from 1 to 1.5 cm, and for those larger than 1 cm, incision ranged from 1.5 to 3 cm. For stones more than 2 cm in diameter, detritus basket rather than simple incision was chosen.


RESULTS
Of the 798 patients with choledocholithiasis, 764 (93.5%) had successful stone clearance, 215 (94.3%) out of 228 cases of stenosing papillitis were cured totally, while 63 had chronic pancreatitis developed from stenosing papillitis, 57 (90.1%) had sound remission of symptoms, though membranous stenosis emerged in 13 of 57 which was treated with balloon dilatation. After the operation, only 21 cases (2.1%) had complications such as severe pancreatitis and incision bleeding. None of the patients died.


CONCLUSIONS
EST is an ideal surgical management with mini-invasion in the treatment of choledocholithiasis and stenosing papillitis.
Li
Zhi-Hua
ZH
Institute of Hepatobiliary Surgery of PLA, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
Chen
Min
M
Liu
Ji-Kui
JK
Ding
Jun
J
Dong
Jia-Hong
JH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D041761:Cholecystolithiasis / Q000601:surgery; D042883:Choledocholithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D046628:Sphincter of Oddi Dysfunction / Q000473:pathology / Q000601:surgery*; D016717:Sphincterotomy, Endoscopic