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[Precut sphincterotomy in impacted choledocholithiasis at the Vater's ampulla]
1Departamento de Endoscopia Digestiva, Hospital de Especialidades Núm. 71, Centro Médico Nacional Torreón, Instituto Mexicano del Seguro Social.
Revista De Gastroenterologia De Mexico
|October 1, 1996
Summary
Precut papillotomy effectively treats impacted common bile duct stones at the ampulla of Vater when standard methods fail. This technique, performed by experienced endoscopists, does not increase complication risks.
Area of Science:
- Gastroenterology
- Endoscopic procedures
- Biliary tract interventions
Background:
- Endoscopic sphincterotomy is standard for common bile duct stones.
- Impacted stones at the ampulla complicate deep cannulation and standard sphincterotomy.
- Precut papillotomy may aid stone extraction but carries potential risks.
Purpose of the Study:
- To evaluate the efficacy of precut papillotomy for impacted common bile duct stones at the ampulla of Vater.
- Assessing precut papillotomy's role in difficult stone extraction scenarios.
Main Methods:
- A retrospective analysis of 27 patients undergoing needle knife precut papillotomy between 1990 and 1995.
- Precut papillotomy was used after conventional sphincterotomy failed due to impacted ampullary stones.
- Facilitated deep cannulation and subsequent standard sphincterotomy in 12 patients.
Main Results:
- Spontaneous stone expulsion occurred in 11 patients after precut papillotomy extension.
- Three patients required a second endoscopic retrograde cholangiopancreatography (ERCP) session due to edema or bleeding.
- One patient experienced mild bleeding requiring hemotransfusion; no perforations or pancreatitis were observed.
Conclusions:
- Precut papillotomy is an effective treatment for impacted common bile duct stones at the ampulla of Vater.
- This technique should be performed by experienced endoscopists.
- Precut papillotomy does not appear to increase the risk of complications.