Endoscopic sphincterotomy before pancreaticoduodenectomy for ampullary carcinoma

Pancreaticoduodenectomy remains the operation of choice for carcinoma of the ampulla of Vater, but the presence of severe jaundice in almost all patients with ampullary neoplasia is a major contributory factor to the high incidence of complications and hospital mortality after the operation. To achieve biliary decompression in five patients endoscopic sphincterectomy was performed at the time of endoscopic retrograde cholangiopancreatography. The procedure was successful in achieving biliary drainage in all cases and was without appreciable morbidity. All five patients subsequently underwent identical resections, the interval to operation being decided by the speed of resolution of the jaundice; minor pancreatic leaks in two patients were the only complications. None of the patients died. These results suggest, therefore, that endoscopic sphincterotomy should be performed at the time of duodenoscopy if an obstructive ampullary tumour is found.