RADIOLOGICAL ASPECTS OF ENDOSCOPIC SPHINC TEROTOMY COMPLICATIONS

Endoscopic sphincterotomy (ES) is a minimally invasive technique which is the standard of reference in many clinical situations (e.g distal choledocolithiasis, recurrent lithiasis or bile duct stenosis). Compli cation are rare but are often misdiagnosed although radiological aspec ts are demonstrative. The purpose of this study is to illustrate the p atterns of the complications. Ten patients have been treated for the l ast four years in our institution for ES complications. There were eig ht cases of pancreatitis, three of which had associated perforation, o ne arterioportal fistula, and one isolated perforation. Diagnosis was reached with CT in all but one case. Two patients have been successful ly treated with percutaneous treatment (one embolization with Gianturc o coils, and one drainage). Two patients died, one of necrotizing panc reatitis and the second of decubitus complication. The other patients were followed with CT. We give examples of different observations and discuss their follow up. The severity and extent of post ES pancreatit is were readily assessed by CT and response to therapy monitored by se rial examinations. Severity of disease, evaluated according to the len gth of hospitalization, correlated well with the presence and degree o f pancreatic necrosis. CT also highlights perforations including minim al effusions. In our study differential diagnosis between post ES panc reatitis and perforation is not significant regarding the initial cons ervative therapy in both situations. CT scan helps us to opt for a sur gical decision or for a percutaneous drainage. It also permits to foll ow the evolution of the lesions. In our cases involving perforations, we noted a spontaneous complete resolution of gas effusion on control and we also observed that pancreatitis evolution was similar to standa rd pancreatitis evolution. In a life threatening post ES hemobilia, no t responding to standard medical treatment, angiography is the diagnos tic exam of choice before embolization which is regarded as the best i nitial treatment of vascular lesions. We conclude that CT is the exam of choice in the initial diagnosis and follow up post ES complications .