Endoscopic sphincterotomy for bile duct stones.

This paper reports the results of endoscopic sphincterotomy for bile duct stones in 50 patients. A design for a spincterotomy handle and a suitable stainless steel diathermy wire are described. Sphincterotomy was achieved in 45 patients (90%) and complete stone clearance in 42 (84%); this usually required two endoscopic examinations. Complications occurred in nine patients. Haemorrhage and pancreatitis were the most serious resulting in one laparotomy (haemorrhage) and one death (pancreatitis). Periampullary diverticula in 11 patients (22%) did not influence the success rate or the frequency of complications. A "pre-cut" in 11 patients (22%) permitted a later successful sphincterotomy in eight. Stone size (up to 3.5 cm) did not appear to influence outcome, but complete stone clearance was only achieved in two out of eight with more than ten bile duct calculi. Symptoms have not recurred up to three years after sphincterotomy. The data indicate that endoscopic sphincterotomy is of major value in high-risk patients with bile duct calculi and is also appropriate for most low-risk patients with retained stones after cholecystectomy.