Selective sphincteroplasty of the papilla in cases at risk due to atypical anatomy.
OBJECTIVE
To analyze the indications, efficacy and safety of sphincteroplasty in our centre.


METHODS
A retrospective study of sphincteroplasty in 53 cases of papilla at high risk was performed in 2004-2006. The procedure consisted of duodenoscopy with Olympus TJF 145 Videoduodenoscope, approach to the biliary tract using a catheter with a guidewire, and dilatation of the papilla with a dilatation balloon catheter using a syringe with a manometer for control of the filling pressure.


RESULTS
The indications included intradiverticular papilla in 26 patients (49%), stenosis of a previous sphincterotomy in 19 patients (35.8%), small size of the papilla in 4 patients (7.5%), Billroth II gastrectomy in 3 patients (5.6%), and coagulopathy in one patient (1.9%). The efficacy was 97.8%, with all the calculi extracted from the common bile duct in 84.4% of the patients, even though 21 of the patients (39.6%) had calculi with a diameter equal to or greater than 10 mm. Seven patients (13.2%) presented complications: haemorrhage in 1 patient (1.9%) and mild pancreatitis in 6 patients (11.3%). The mean hospital stay in case of complications was of 3 +/- 0.63 d.


CONCLUSIONS
Sphincteroplasty is highly effective, with a complication rate similar to that of sphincterotomy, furthermore, the complications are of low clinical importance. The use of the 10 mm balloon makes it possible to extract calculi with a diameter of over 15 mm and to extract more than 3 calculi without increasing the rate of complications and reduces the need to resort to lithotripsy or rescue sphincterotomy.
Mugica
F
F
Gastroenterology Department, Donostia Hospital, San Sebastian, Spain. fmugica@chdo.osakidetza.net
Urdapilleta
G
G
Castiella
A
A
Berbiela
A
A
Alzate
F
F
Zapata
E
E
Zubiaurre
L
L
Lopez
P
P
Arenas
J-I
JI
D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000002:abnormalities* / Q000601:surgery; D001652:Bile Ducts / Q000002:abnormalities / Q000601:surgery; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D009803:Sphincter of Oddi / Q000002:abnormalities / Q000601:surgery; D013105:Sphincterotomy, Transduodenal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*