Duodenoscopic sphincterotomy and gallstone removal.

Duodenoscopic sphincterotomy was attempted in 265 patients. The procedure was successful in 243 patients (92%). Indications for sphincterotomy were: 185 patients with choledocholithiasis, 52 patients with papillary stenosis, and 6 patients with ampullary carcinoma. The clinical and biochemical evidence of cholestasis resolved in 222 of the 243 successful patients (91%). Complications consisting of hemorrhage, perforation, pancreatitis, cholangitis, and instrumental injury resulted in three deaths, an over-all mortality of 1.2%. Emergency laparotomy was required in 6 cases (2.5%). Duodenoscopic sphincterotomy is a relatively safe and effective means of relieving certain instances of extrahepatic cholestasis. The complication and mortality rates appear lower than those with equivalent conventional surgical techniques.