Endoscopic sphincterotomy in biliary tract disease

In many centers endoscopic sphincterotomy is replacing surgery, which has never been an ideal treatment for retained common duct calculi. We attempted endoscopic sphincterotomy in 70 patients, succeeding in 60 (85%). Sixty-one patients had choledocholithiasis (58 postcholecystectomy), 7 had papillary stenosis, 1 carcinoma of the papilla of Vater, and 1 hydatid disease. Repeat cholangiography in 56 patients with gallstones showed spontaneous passage in 44. In three patients the sphincterotomy required extension, and in three the stones were extracted using a Dormia basket. In four patients the stones did not pass, and surgical removal was necessary. Satisfactory biliary drainage was obtained in all the other patients, and the only complications noted were cholangitis and severe pancreatitis. Endoscopic sphincterotomy is reasonably safe and an acceptable, if not preferable, alternative to surgical removal of retained gallstones, and it is also effective in relieving papillary stenosis.