Complications of endoscopic biliary sphincterotomy: a review

Short-term complications of sphincterotomy can vary widely in different circumstances, and appear to be related primarily to two factors: the indication for the procedure, and the technical skill of the endoscopist. The risk of sphincterotomy is highest when it is performed for suspected sphincter of Oddi dysfunction, and lowest when it is performed for bile duct stone extraction in tandem with laparoscopic cholecystectomy. The endoscopic technique is an important factor in complications, and this is in turn related to the case volume, and presumably the skill and training of the endoscopist. With the exception of cirrhosis and perhaps other specific conditions, the patient's general medical condition appears to have little impact on the overall risk of sphincterotomy. Complications represent only one facet of negative outcomes in attempted sphincterotomy: failure to achieve bile duct access at all, failure of completed sphincterotomy to achieve its intended therapeutic response, and its long-term sequelae, may be at least as important in determining the overall outcome of sphincterotomy.