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[Endoscopic sphincteroplasty (not sphincterotomy) using the clips--a preliminary report]
S Matsumoto1, S Ikeda, M Tanaka
1First Department of Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Nihon Geka Gakkai Zasshi
|January 1, 1993
Summary
Endoscopic sphincteroplasty using clips may prevent complications like restenosis and cholangitis after bile duct procedures. This study in dogs showed clips effectively approximated tissues, ensuring a wide opening and preventing stenosis.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Endoscopic Procedures
Background:
- Incomplete endoscopic sphincterotomy can lead to restenosis, cholangitis, and stone recurrence.
- Surgical sphincterotomy has evolved to sphincteroplasty, prompting investigation into endoscopic sphincteroplasty feasibility.
Purpose of the Study:
- To evaluate the feasibility and efficacy of endoscopic sphincteroplasty in preventing complications associated with biliary access.
Main Methods:
- 36 dogs underwent papilla division; 12 had tissue approximation with sutures, 12 with endoscopic clips, and 12 received no approximation.
- Post-operative blood chemistry, duodenobiliary barium regurgitation, and macro/microscopic examination of the papilla were assessed.
Main Results:
- Clip approximation was comparable to sutures for hemostasis and leakage prevention, resulting in wide openings and free regurgitation.
- The no-treatment group exhibited abnormal liver function and amylase levels, with high rates of leakage, abscess, and papilla stenosis.
- Endoscopic sphincteroplasty with clips demonstrated promising results in maintaining patency and preventing adverse outcomes.
Conclusions:
- Endoscopic sphincteroplasty, particularly using clips for tissue approximation, appears feasible and effective in preventing complications like stenosis and leakage.
- The findings support the potential of endoscopic sphincteroplasty as a viable alternative to traditional methods, with a successful clinical case described.