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. 1998 Feb;227(2):201–204. doi: 10.1097/00000658-199802000-00008

Endoscopic sphincterotomy for stones by experts is safe, even in younger patients with normal ducts.

P B Cotton 1, J E Geenen 1, S Sherman 1, J T Cunningham 1, D A Howell 1, D L Carr-Locke 1, N J Nickl 1, R H Hawes 1, G A Lehman 1, A Ferrari 1, A Slivka 1, D R Lichtenstein 1, J Baillie 1, P S Jowell 1, L M Lail 1, H Evangelou 1, J J Bosco 1, B L Hanson 1, B J Hoffman 1, S M Rahaman 1, R Male 1
PMCID: PMC1191236  PMID: 9488517

Abstract

OBJECTIVE: To provide current information on the risks of endoscopic sphincterotomy for stone. SUMMARY BACKGROUND DATA: In recent years (since the popularity of laparoscopic cholecystectomy), endoscopic sphincterotomy has been used increasingly for the management of bile duct stones in relatively young and healthy patients. The validity of this trend has been questioned using data on short-term complications derived from earlier decades that involved more elderly and high-risk patients. METHODS: Seven academic centers collected data prospectively using a common database. Complications within 30 days of the procedures were documented by standard criteria. RESULTS: Of 1921 patients, 112 (5.8%) developed complications; two thirds of these events were graded as mild (<3 days in hospital). There was no evidence of increased risk in younger patients or in those with smaller bile ducts. There was only one severe complication and there were no fatalities in 238 patients age <60, with bile duct diameters of <9 mm. CONCLUSION: Sphincterotomy for stones can be performed very safely by experienced endoscopists.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cetta F. Common duct stones in the era of laparoscopic cholecystectomy: changing treatments and new pathologic entities. J Laparoendosc Surg. 1994 Feb;4(1):41–44. doi: 10.1089/lps.1994.4.41. [DOI] [PubMed] [Google Scholar]
  2. Chen Y. K., Foliente R. L., Santoro M. J., Walter M. H., Collen M. J. Endoscopic sphincterotomy-induced pancreatitis: increased risk associated with nondilated bile ducts and sphincter of Oddi dysfunction. Am J Gastroenterol. 1994 Mar;89(3):327–333. [PubMed] [Google Scholar]
  3. Cotton P. B. Endoscopic management of bile duct stones; (apples and oranges). Gut. 1984 Jun;25(6):587–597. doi: 10.1136/gut.25.6.587. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cotton P. B. Is your sphincterotomy really safe--and necessary? Gastrointest Endosc. 1996 Dec;44(6):752–755. doi: 10.1016/s0016-5107(96)70068-8. [DOI] [PubMed] [Google Scholar]
  5. Cotton P. B., Lehman G., Vennes J., Geenen J. E., Russell R. C., Meyers W. C., Liguory C., Nickl N. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991 May-Jun;37(3):383–393. doi: 10.1016/s0016-5107(91)70740-2. [DOI] [PubMed] [Google Scholar]
  6. Davis W. Z., Cotton P. B., Arias R., Williams D., Onken J. E. ERCP and sphincterotomy in the context of laparoscopic cholecystectomy: academic and community practice patterns and results. Am J Gastroenterol. 1997 Apr;92(4):597–601. [PubMed] [Google Scholar]
  7. Freeman M. L., Nelson D. B., Sherman S., Haber G. B., Herman M. E., Dorsher P. J., Moore J. P., Fennerty M. B., Ryan M. E., Shaw M. J. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996 Sep 26;335(13):909–918. doi: 10.1056/NEJM199609263351301. [DOI] [PubMed] [Google Scholar]
  8. Hawes R. H., Cotton P. B., Vallon A. G. Follow-up 6 to 11 years after duodenoscopic sphincterotomy for stones in patients with prior cholecystectomy. Gastroenterology. 1990 Apr;98(4):1008–1012. doi: 10.1016/0016-5085(90)90026-w. [DOI] [PubMed] [Google Scholar]
  9. Hunter J. G. Laparoscopic cholecystectomy and the common bile duct. Surg Endosc. 1994 Apr;8(4):285–286. doi: 10.1007/BF00590952. [DOI] [PubMed] [Google Scholar]
  10. Johnston G. W. Iatrogenic chymobilia--a disease of the nineties? HPB Surg. 1991 Sep;4(3):187–190. doi: 10.1155/1991/26202. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Kozarek R. A. Laparoscopic cholecystectomy: what to do with the common duct. Gastrointest Endosc. 1993 Jan-Feb;39(1):99–101. doi: 10.1016/s0016-5107(93)70026-7. [DOI] [PubMed] [Google Scholar]
  12. May G. R., Cotton P. B., Edmunds S. E., Chong W. Removal of stones from the bile duct at ERCP without sphincterotomy. Gastrointest Endosc. 1993 Nov-Dec;39(6):749–754. doi: 10.1016/s0016-5107(93)70258-8. [DOI] [PubMed] [Google Scholar]
  13. Moreaux J. Traditional surgical management of common bile duct stones: a prospective study during a 20-year experience. Am J Surg. 1995 Feb;169(2):220–226. doi: 10.1016/S0002-9610(99)80141-X. [DOI] [PubMed] [Google Scholar]
  14. Perissat J., Huibregtse K., Keane F. B., Russell R. C., Neoptolemos J. P. Management of bile duct stones in the era of laparoscopic cholecystectomy. Br J Surg. 1994 Jun;81(6):799–810. doi: 10.1002/bjs.1800810606. [DOI] [PubMed] [Google Scholar]
  15. Prat F., Malak N. A., Pelletier G., Buffet C., Fritsch J., Choury A. D., Altman C., Liguory C., Etienne J. P. Biliary symptoms and complications more than 8 years after endoscopic sphincterotomy for choledocholithiasis. Gastroenterology. 1996 Mar;110(3):894–899. doi: 10.1053/gast.1996.v110.pm8608900. [DOI] [PubMed] [Google Scholar]
  16. Sherman S., Ruffolo T. A., Hawes R. H., Lehman G. A. Complications of endoscopic sphincterotomy. A prospective series with emphasis on the increased risk associated with sphincter of Oddi dysfunction and nondilated bile ducts. Gastroenterology. 1991 Oct;101(4):1068–1075. [PubMed] [Google Scholar]
  17. Strasberg S. M., Callery M. P., Soper N. J. Laparoscopic surgery of the bile ducts. Gastrointest Endosc Clin N Am. 1996 Jan;6(1):81–105. [PubMed] [Google Scholar]
  18. Strasberg S. M., Soper N. J. Management of choledocholithiasis in the laparoscopic era. Gastroenterology. 1995 Jul;109(1):320–322. doi: 10.1016/0016-5085(95)90302-x. [DOI] [PubMed] [Google Scholar]
  19. Vitale G. C., Larson G. M., Wieman T. J., Cheadle W. G., Miller F. B. The use of ERCP in the management of common bile duct stones in patients undergoing laparoscopic cholecystectomy. Surg Endosc. 1993 Jan-Feb;7(1):9–11. doi: 10.1007/BF00591228. [DOI] [PubMed] [Google Scholar]
  20. Wilson M. S., Tweedle D. E., Martin D. F. Common bile duct diameter and complications of endoscopic sphincterotomy. Br J Surg. 1992 Dec;79(12):1346–1347. doi: 10.1002/bjs.1800791234. [DOI] [PubMed] [Google Scholar]

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