Intraduodenal manipulations of the common bile duct.

The history of the development and technique of endoscopic sphincterotomy are discussed. This includes a review of 796 successful sphincterotomies out of 838 attempts. The indications for sphincterotomy were choledocholithiasis in 632 patients, stenosis of the papilla of Vater in 136, periampullary tumor in 24, and stones in the main pancreatic duct in 4 patients. Of 632 patients with choledocholithiasis, 234 passed the stone spontaneously, and 358 has the stone extracted. Residual stones remained in 40 patients. Complications, such as bleeding, retroperitoneal perforation, pancreatitis, cholangitis, and impaction of the Dormia basket, were noted. This indicates a morbidity of 6.9 percent. Fifteen patients required laparotomy. The overall mortality was 1.13 percent. Endoscopic laparotomy. The overall mortality was 1.13 percent. Endoscopic sphincterotomy is a relatively safe and effective method for treatment of extrahepatic cholestasis. The complication rate for patients at high risk is significantly lower than for patients undergoing conventional transabdominal operations.