COMPLICATIONS OF ENDOSCOPIC BILIARY SPHINCTEROTOMY

Background Endoscopic sphincterotomy is commonly used to remove bile-d uct stones and to treat other problems. We prospectively investigated risk factors for complications of this procedure and their outcomes. M ethods We studied complications that occurred within 30 days of endosc opic biliary sphincterotomy in consecutive patients treated at 17 inst itutions in the United States and Canada from 1992 through 1994. Resul ts Of 2347 patients, 229 (9.8 percent) had a complication, including p ancreatitis in 127 (5.4 percent) and hemorrhage in 48 (2.0 percent). T here were 55 deaths from all causes within 30 days; death was directly or indirectly related to the procedure in 10 cases. Of five significa nt risk factors for complications identified in a multivariate analysi s, two were characteristics of the patients (suspected dysfunction of the sphincter of Oddi as an indication for the procedure and the prese nce of cirrhosis) and three were related to the endoscopic technique ( difficulty in cannulating the bile duct, achievement of access to the bile duct by ''precut'' sphincterotomy, and use of a combined percutan eous-endoscopic procedure). The overall risk of complications was not related to the patient's age, the number of coexisting illnesses, or t he diameter of the bile duct. The rate of complications was highest wh en the indication for the procedure was suspected dysfunction of the s phincter of Oddi (21.7 percent) and lowest when the indication was rem oval of bile-duct stones within 30 days of laparoscopic cholecystectom y (4.9 percent). As compared with those who performed fewer procedures , endoscopists who performed more than one sphincterotomy per week had lower rates of complications (8.4 percent vs. 11.1 percent, P=0.03). Conclusions The rate of complications after endoscopic biliary sphinct erotomy can vary widely in different circumstances and is primarily re lated to the indication for the procedure and to endoscopic technique, rather than to the age or general medical condition of the patient.