Endoscopic papillotomy in the treatment of biliary tract disease: 258 procedures and results.

Endoscopic papillotomy has been successfully performed in 258 of 267 patients (96.6%) presenting with common duct stones, papillary stenosis, or ampullary adenocarcinoma. A low morbidity was experienced (5%) while mortality was 0.77% (2 deaths). Surgical intervention was necessary in 2 patients. The mean age of the group is 66.4 years (range 26-95 years), while the mean hospital stay remains low at 3 days (range 1-12) days. The procedure has proven to be safe and effective, creating a permanent biliary enteric fistula comparable to standard surgical procedures, but does not require a laparotomy/duodenotomy. Eliminating the latter reduces morbidity, immobility, and convalescence. Papillotomy is not a procedure to be performed by inexperienced endoscopists as it is the only endoscopic procedure with predictable morbidity and mortality. In order to maintain the progress achieved to date, papillotomy should be performed by those with extensive endoscopic experience in the diagnostic area before embarking onto the therapeutic procedure.