Methods of performing sphincterotomy: Biliary and pancreatic

Endoscopic sphincterotomy (ES) has been performed for 30 years and is the therapeutic procedure of choice for management of choledocholithiasis, cholangitis, biliary pancreatitis, and other biliary and pancreatic problems. Sphincterotomy is commonly performed on the biliary and pancreatic sphincters in addition to the minor papilla. A variety of sphincterotomes are manufactured for use in a range of clinical settings. Specialized techniques including precut sphincterotomy and transpancreatic sphincter precut have been developed to perform sphincterotomy in cases where selective cannulation of the bile duct is not possible. Sphincterotomy can also be performed using a stent as a guide. Early and late complications can occur following sphincterotomy. Early complications include pancreatitis, hemorrhage, perforation and cholangitis; the incidence of complications has been shown to be related to endoscopic technique, procedure volume, and indication for the procedure. Late complications include choledocholithiasis, stenosis and cholangitis. These are usually related to patient factors such as bile duct size and the size of the sphincterotomy. As endoscopic retrograde cholangiopancreatography is becoming a procedure for therapy rather than diagnosis, all endoscopists performing endoscopic retrograde cholangiopancreatography should be able to perform sphincterotomy. © 2003 Elsevier Inc. All rights reserved.

Duke Scholars

Author Malcolm Stanley Branch Medicine, Gastroenterology