Endoscopic Sphincterotomy and Removal of Common Duct Stones

Seiyo Ikeda

First Department of Surgery, Fukuoka University School of Medicine

Endoscopic sphincterotomy (EST) is a safe and effective alternative to surgery for the treatment of common bile duct stones. It is extremely useful especially for patients with acute obstructive suppurative cholangitis (AOSC) or gallstone pancreatitis, and high-risk patients with serious complications. We have performed EST in 1,080 patients with choledocholithiasis since October 1974. The success rates for EST and stone removal were very high, 98.9% and 93.1%, respectively. Immediate complications occurred in 82 patients (7.6%). One patient died of AOSC and another of acute pancreatitis in the early phase of our experience, yielding a mortality rate of 0.2%. The long-tipped sphincterotome allows easy control of incision, contributing to zero incidence of duodenal perforation. As precutting may increase the risk of acute pancreatitis, selective bile duct cannulation should be first attempted with the use of a guide wire. Long-term follow-up was completed in 140 of 141 patients with common bile duct stones more than 10 years after sphincterotomy. Recurrent stones developed in 18 patients (12.9%). Recurrence of common bile duct stones has a tendency to increase with time.

Key words
endoscopic sphincterotomy, endoscopic gallstone removal, long-term results of endoscopic sphincterotomy

Reprint requests
Seiyo Ikeda First Department of Surgery, School of Medicine, Fukuoka University
7-45-1 Nanakuma, Johnan-ku, Fukuoka, 814-01 JAPAN

Accepted
May 11, 1993

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