[Surgical or endoscopic papillotomy? (author's transl)]

Area of Science:

• Gastroenterology and Hepatology
• Minimally Invasive Procedures
• Biliary Tract Interventions

Context:

• Endoscopic papillotomy has emerged as a primary treatment modality, supplanting traditional surgical techniques for various biliary conditions.
• The study defines specific indications for both endoscopic and surgical interventions based on the location and nature of the pathology.

Purpose:

• To compare the efficacy, safety, and complication rates of endoscopic papillotomy versus surgical methods for treating choledochal and peripapillary alterations.
• To delineate the precise indications for each procedure and analyze outcomes based on a substantial case series.

Summary:

• Endoscopic papillotomy is indicated for direct treatment of the papilla and peripapillary region of the common bile duct.
• Surgical intervention is reserved for gallbladder diseases, additional procedures, or when endoscopic treatment fails.
• The study analyzed 211 surgical and 714 endoscopic papillotomies, detailing complication and mortality rates for each approach.

Impact:

• Endoscopic papillotomy exhibits a significantly lower complication rate (6.7%) compared to surgery (approximately 20%).
• Mortality rates favor endoscopy (1.5%) over surgery (3.8%), highlighting its improved safety profile.
• This research provides critical data for clinicians selecting the optimal treatment strategy for patients with choledochal pathologies.