REMOVAL OF STONES FROM THE BILE-DUCT AT ERCP WITHOUT SPHINCTEROTOMY

The main risks associated with endoscopic stone removal arise from the sphincterotomy that is performed to facilitate stone extraction. The complication rate may be higher when the bile duct is not dilated. Bet ween January 30, and March 30,1993, we attempted to remove stones up t o 8 mm in diameter through the intact papilla, without performing sphi ncterotomy, in 24 patients. Nine patients underwent balloon dilation o f the sphincter or of a low duct stricture to facilitate stone removal . All patients were treated successfully and are well at follow-up. Tw o patients (one having had balloon dilation of the sphincter) had mild pancreatitis that required 2 days in the hospital. During the same pe riod, 215 patients were treated for duct stones 8 mm or less through a standard sphincterotomy. Complications occurred in 11 of these patien ts: five episodes of pancreatitis, three infections, one perforation, and two other complications. Although these two groups of patients are not directly comparable, it appears that selected stones can be extra cted from the bile duct without sphincterotomy with relative safety. T his technique should be studied further, especially in younger persons where sphincter preservation may be desirable.