Endoscopic papillotomy: sphincterotomy or sphincteroplasty.

An ongoing series of patients who were treated with endoscopic papillotomy (EPT) for retained or recurrent common bile duct gallstones or papillary stenosis was analyzed for safety and efficacy of the procedure and compared with accepted surgical technics, sphincterotomy and sphincteroplasty. To date, endoscopic papillotomy was attempted in 77 patients and successful in 71 (92%). The mean hospital stay is 3.1 days (range one to 12 days), convalescence has been short and morbidity has been low. One death has occurred in the series and no patients have been subjected to surgical intervention. Evaluation of the results achieved after papillotomy were compared with surgical technics and revealed that a sphincteroplasty was achieved in 68% of the patients and sphincterotomy in 32%. The results of EPT, therefore, have been extremely encouraging establishing EPT as a first line treatment modality for common bile duct stones and papillary stenosis. As, however, EPT is the only endoscopic procedure with predictable morbidity and mortality, it should be performed by skilled, experienced endoscopists in centers with cooperating surgeons so that it will remain an accepted modality in the treatment of biliary tract disorders.