ENDOSCOPIC PAPILLOTOMY

Abstract

Obstruction of the common bile duct can now be relieved by endoscopic electrosurgery. On 192/222 patients with choledocholithiasis all calculi were evacuated by endoscopic papillotomy (EP). Remaining patients had EP because of papillary stenosis. Complications of EP included 9 instances of pancreatitis, 7 of bleeding and 3 perforations. In 2/32 patients having EP for papillary stenosis, restenosis appeared on follow-up. The 2 fatalities were attributable to purulent cholangitis and acute bleeding. This complication rate is less than that reported for traditional surgical procedures required to manage these situations. The endoscopic method requires less hospitalization and recuperation. EP and stone extraction are methods of choice for managing common duct obstruction in high risk patients before cholecystectomy, for retained or reformed stones after cholecystectomy and for papillary stenosis.