Diagnosis of papillary stenosis by calibration: follow-up 15 to 25 years after sphincteroplasty.

In 178 patients undergoing elective cholecystectomy for biliary colic, the papilla was calibrated with a no. 10 French catheter through the cystic duct. The catheter passed through the papilla into the duodenum in 94 patients. Six (6 percent) had common duct stones. No postcholecystectomy colic occurred. In 37 patients the catheter was obstructed by papillary stenosis and sphincteroplasty was done. Common duct stones occurred in 17 patients (46 percent), jaundice in 7 and dilatation of the common duct in 6. Cholangiograms failed to detect small stones in seven patients and were of minimal value in positively identifying stenosis. In 49 control patients the papilla was not calibrated. Cholangiograms were normal. Postcholecystectomy colic occurred in seven patients, two of whom underwent subsequent sphincteroplasty. It is concluded that calibration is a worthwhile adjunct to cholangiography. Sphincteroplasty permits passage of small stones that may not be apparent on cholangiograms and are retained by papillary stenosis, and prevents colic (dyskinesia) of stenosis that also may not be apparent on cholangiograms.