Endoscopic Sphincterotomy and Stone Extraction

Recent development of new cannulation techniques, improvement of lithotripsy methods, and the advent of laparoscopic cholecystectomy have extended the efficacy and broadened the application of endoscopic sphincterotomy and stone extraction. Choledocholithiasis, a condition that once was believed to invariably require surgical intervention, now can successfully be treated endoscopically in 85% to 90% of cases, with a complication rate of 7% to 10% and a mortality rate of 0.5% to 1.0%. In patients scheduled for laparoscopic cholecystectomy in whom bile duct stones are suspected, the indication and timing of perioperative endoscopic retrograde cholangiopancreatography depend on the likelihood of ductal stones being present as well as local endoscopic expertise. The increase in the number of younger patients referred for endoscopic stone extraction, mainly as a consequence of the advent of laparoscopic cholecystectomy, and the unknown long-term effects of sphincterotomy have led to the development of techniques in which stones are extracted from the bile duct without sphincterotomy. This article concentrates on the technique of endoscopic sphincterotomy and stone extraction, defines its indications (with special reference to laparoscopic cholecystectomy) and discusses occurrence and management of complications.