Endoscopic sphincterotomy for bile duct stones

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Abstract
The results of endoscopic sphincterotomy for bile duct stones in 50 patients is reported. A design for a sphincterotome handle and a suitable stainless steel diathermy wire are described. Sphincterotomy was achieved in 45 patients (90%) and complete stone clearance in 42 (84%); this usually required 2 endoscopic examinations. Complications occurred in 9 patients. Hemorrhage and pancreatitis were the most serious resulting in 1 laparotomy (hemorrhage) and 1 death (pancreatitis). Periampullary diverticula in 11 patients (22%) did not influence the success rate or the frequency of complications. A pre-cut in 11 patients (22%) permitted a later successful sphincterotomy in 8. Stone size (up to 3.5 cm) did not appear to influence outcome, but complete stone clearance was only achieved in 2 out of 8 with more than 10 bile duct calculi. Symptoms have not recurred up to 3 yr after sphincterotomy. Endoscopic sphincterotomy is apparently of major value in high-risk patients with bile duct calculi and is apparently, also appropriate for most low-risk patients with retained stones after cholecystectomy.