A study of endoscopic sphincterotomy in recurrent pyogenic cholangitis.

Recurrent pyogenic cholangitis is a condition prevalent in Asia. Surgery has been the only form of treatment when extrahepatic and/or intrahepatic biliary dilatation, irregularity, debris and calculi are present. Endoscopic sphincterotomy was attempted in 134 such patients, the majority of whom had calculi confined to the common bile duct, and in whom 85.8 per cent were over 60 years old, 61.2 per cent had previous biliary surgery, and 36.6 per cent had an associated major medical illness. Sphincterotomy was successful in 88 per cent of patients, good results were obtained in 81.3 per cent, and stone removal was achieved in 91.7 per cent of those with demonstrable biliary calculi. Major complications occurred in 7.5 per cent, resulting in emergency surgery in 3 per cent and death in 1.5 per cent. The mortality of surgical sphincteroplasty in 143 patients with this condition who were over 60 years old was known to be 7 per cent. Five of 109 patients without residual calculi after endoscopic sphincterotomy developed mild to moderate symptoms after a follow-up period of 6 months to 6 years (median 2.3 years). Endoscopic sphincterotomy is a safe and effective form of treatment in patients with recurrent pyogenic cholangitis whose calculi are confined to the common bile duct.